Veridian Connections

Pre-Authorized Payment

Benefits of our Pre-Authorized Payment Plan:

Economical – no postage or service charges
Secure – no delayed payments or lost in transit
Convenient – no cheques to write
No late penalty charges – even when you are away
No trips to drop boxes or to the bank to make payments
Select Equal Payments or Variable Payments
Easy - complete the Online Enrollment Form
OR download the PDF Enrollment Form ( Equal Payments (PDF) | Variable Payments (PDF) )
and fax, mail or email it with a VOID cheque to:

VERIDIAN CONNECTIONS Inc.
55 Taunton Road East
Ajax, ON L1T 3V3
Fax number: 905-837-7861
Email: billingenquiries@veridian.on.ca

Pre-authorized Payment Request

First Name:*

Last Name:*

Account Number:*

Street Address:*

City:*

Postal/Zip Code:*

Telephone (Home):*

Telephone (Work):

Email Address:

Select a Pre-authorized Payment Plan:*

Equalized on the 15th of the month
Equalized on the 28th of the month
Variable (full amount drawn on due date)

Name of Financial Institution:*

To complete your sign-up, mail or fax a VOID cheque to:


Mail to:		Veridian Connections, 55 Taunton Road East, Ajax, ON L1T 3V3

Fax to:		905-837-7861

* I/we authorize VERIDIAN and the financial institution designated above to begin deductions for payment of my/our Veridian account. This authorization is to remain in effect until Veridian has received written notification from me/us of its termination in time to allow reasonable opportunity for Veridian to act upon this request. Upon such termination any balance due must be paid to Veridian. This authorization may be terminated at any time by Veridian.