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.
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