Subscribe – Crossroads Gas Co-op Ltd.

Name

Phone number

Gas account number

If you don’t have an account number yet, please write New in the field above

Please sign me up for:

Customer Portal
Emailed bills
Equalized Payment Plan (only in the spring time)
Pre-Authorized Debit (fill out below)

Transit Number (5 digits)

Transit Phone is

Institution Number (3 digits)

Bank Account Number

This gas service is for:*

Personal use
Business (commercial activities)

Pre-Authorized Debit (PAD) Agreement*

I have read and agree to the PAD Agreement*

You, the Payor, authorize Crossroads Gas Co-op Ltd. to debit the bank account identified above for the exact amount of the accounts outstanding balance. Date of the withdrawal will be the 22nd of each month, or the next business day. Crossroads needs 4 business days prior to the 22nd of the month to set up, change or cancel your pre-authorized debit. Crossroads will provide at least 10 days notice of the amount of each debit. This authority is to remain in effect until you notify Crossroads of its termination. You have certain recourse rights if any debit does not comply with this agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consistent with the PAD Agreement. For more information on your rights to cancel a PAD Agreement or your recourse rights, contact your financial institution or visit www.payments.ca. Crossroads Gas Co-op Ltd. 36060 Range Road 282 Red Deer County, AB T4G 0G6 403-227-4861.

Comment or Message

Thank you for filling out this form. We will contact you if we need more information.