The Broker Direct Deposit Request Form
*required fields Note: please use your TAB key to navigate.
Company Name
*
Broker Name
*
Initial Request
Change in Banking Information
Cancellation
*
*Note: To ensure accuracy you must mail an ORIGINAL PERSONAL VOID CHEQUE.
It is understood that:
This banking information will be used solely for the purpose of depositing broker commissions.
This information will be held in the broker contract file.
AVP Financial Corp. reserves the right to pay broker commissions by cheque at any time.
It is the sole responsibility of the broker to ensure the accuracy of the banking information provided above.
Any subsequent changes in banking information must be reported in a timely fashion.
AVP Financial Corp. may terminate payment by Direct Deposit without prior notice or authorization from the broker.
If you wish to receive notification of deposit via email, please provide an email address below. Otherwise, notification will be mailed.
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Broker Signature
Broker Email
Date
AVP Health & Welfare Trust
222, 855 - 42 Avenue SE
Calgary AB T2G 1Y8
Questions?
Call: 403.214.3213 or 888.214.3211
Toll Free Fax: 866.213.5514
E-mail:
info@bizflex.ca
www.bizflex.ca