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Checklist and model Payor’s PAD Agreements

To find out which model Payor's PAD Agreement you should use based on the type of pre-authorized PAD, see Checklist for each type of PAD - This link will open in a new window. (PDF, 739 KB).

Model Payor's PAD Agreements

The models below meet Rule H1 requirements. They can be personalized, in Word, but mandatory provisions must be maintained. However, the approval process with AccèsD Affaires will be faster if you use the model as is.

PDF models let you include your company logo and can be filled out in electronic version.

The last model in non-modifiable PDF is modeled on the model for fixed interval PADs, but it also includes a legend illustrating the 7 mandatory elements described in Rule H1.

Model fixed interval PADs (most common):

Model sporadic PADs:

Model fixed interval PADs with legend:

Useful links