Pay by Check form     * Required Fields PREVIOUS * First Name: * Last Name: * Email Address: * Confirm Email Address: * Address: * City: * Province: * Postal Code: BANKING INFO * Bank Name: * Transit # (4-5 digits): * Institution # (3 digits): * Account #: *  Question / Suggestion / Feedback

By clicking on "submit", I hereby authorize MTL Telecom to debit my bank account of the amount due shown on my monthly subscription. I declare that the information given on this form is true and complete. I consent and agree to allow Mtl Telecom to make preauthorized payments, under applicable law. I understand that the above data requested is necessary for Mtl Telecom to process my registration and if I fail to provide the same to Mtl Telecom, Mtl Telecom may decline to provide its service to me. I also agree to abide by the Terms & Conditions for using Mtl Telecom services and amendments thereafter stipulated by Mtl Telecom from time to time upon acceptance of my registration herein. A service charge of $10.00 will be applied to any returned checks, or pre-authorized payment charge backs.

Par les présentes, j'autorise Mtl Telecom et l'établissement financier  mentionné ci-dessus à débloquer les fonds nécessaires au paiement des frais mensuels qui me sont facturés, et ce, sous forme de transactions mensuelles autorisées. Toutes les modalités sont assujetties à l'entente conclue avec mon établissement financier. Un frais de service de $10 sera ajouté pour tous paiements refusés à cause de fonds insuffisants.