This form is used by debtors to have payments directly withdrawn from their bank accounts or deducted by their employer from their paycheques. This eliminates the need to send in monthly payments by cheque or money order though MEP. Please note that your bank and employer information is kept confidential.

Notice to users:

This site uses JavaScript code to ensure that personal information entered into fill & print PDF forms is not displayed to subsequent users of the computer. This requires that any computer on which these forms are to be completed must have JavaScript turned on. Print only forms are available for printing if JavaScript cannot be turned on.

Unless you expect to need more than one browser session to complete the form, we recommend that you set Acrobat Reader NOT to keep forms data temporarily available on disk. To change this setting, click Edit, then Preferences, then Forms in Acrobat or Acrobat Reader and uncheck the item labeled "Keep forms data temporarily available on disk".