Personal Lines Payment Agreement.

Terms and Conditions

INSURED/BORROWER AUTHORIZATION AND PRIVACY AUTHORIZATION ^{__________________}

By signing this Payment Agreement, the Insured/Borrower (referred to below as “We” or “us” or “our”):

• acknowledges reading and understanding the AGREEMENTS OF INSURED/BORROWER of this Payment Agreement as outlined on the following pages; and
• consents to the collection, use and disclosure of my personal information for the purposes of: (i) assessing eligibility for and managing credit facilities, (ii) evaluating ongoing credit risk, including obtaining immediate and supplemental/ongoing credit checks of my financial and credit history from credit reporting agencies and those financial institutions which have relevant information on me and ensuring the integrity of the credit reporting information, (iii) fulfilling IPFS Canada’s obligations under the Payment Agreement, and (iv) as further described in the privacy policy available at https://www.ipfscanada.com/privacy-policy or on request; and
• acknowledges that my personal information may be stored and processed outside of Canada, including in the United States, and disclosure may be compelled by foreign courts, law enforcement and national security authorities.

PAYMENT AGREEMENT ^{_________________________________________________________________}

Imperial PFS Canada (“IPFS Canada”) is hereby authorized to draw payment under its Payment Agreement (“PA”) from the Payment Details provided above to cover the payments and other amounts due under this PA. This authorization shall extend to include any revised payment amounts, late charges, NSF charges and other amounts due to IPFS Canada under the terms of this PA. I agree that revised debits may occur prior to receiving written notice of the change in the amount paid. I also understand that if I wish to change the amount of my pre-authorized debit (PAD) I should contact IPFS Canada by phone at (866) 815-9454 or in writing at premiumfinance@ipfscanada.com and/or Imperial PFS Canada, 1011-1 Toronto Street, Toronto, ON M5C 2V6. This authorization is a Personal PAD and may be cancelled at any time by me upon 30 days written notice to IPFS Canada, but cancellation does not affect my obligation to continue to make payments under the PA. I acknowledge that I have certain recourse rights if any debit does not comply with this PA. For example, I have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD and PA. To obtain more information on my rights or a sample cancellation form, I should contact my financial institution or visit www.payments.ca.

I understand that the Term of this PA is

PAYMENT AGREEMENT ^{_________________________________________________________________}

Imperial PFS Canada (“IPFS Canada”) is hereby authorized to draw payment under its Payment Agreement (“PA”) from the Payment Details provided above to cover the payments and other amounts due under this PA. This authorization shall extend to include any revised payment amounts, late charges, NSF charges and other amounts due to IPFS Canada under the terms of this PA. I agree that revised debits may occur prior to receiving written notice of the change in the amount paid. I also understand that if I wish to change the amount of my pre-authorized debit (PAD) I should contact IPFS Canada by phone at (866) 815-9454 or in writing at premiumfinance@ipfscanada.com and/or Imperial PFS Canada, 1011-1 Toronto Street, Toronto, ON M5C 2V6. This authorization is a Personal PAD and may be cancelled at any time by me upon 30 days written notice to IPFS Canada, but cancellation does not affect my obligation to continue to make payments under the PA. I acknowledge that I have certain recourse rights if any debit does not comply with this PA. For example, I have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD and PA. To obtain more information on my rights or a sample cancellation form, I should contact my financial institution or visit www.payments.ca.

I understand that the Term of this PA is