This form is for online remitting only. Click Here for print version.

Debonair Campground Annual Remittance Form

Policy Holder First Name *

Policy Holder Last Name *

Campsite # *

First & Last Name of Spouse/Partner if applicable

Select Address Choice *

Street Address *

City/Town *

Province *

Other Province/State *

Postal/Zip Code *

Primary Phone # *

Alternate Phone #

Alternate Phone # (optional)

Primary Email Address *

Confirm Primary Email address: *

Secondary Email Address (optional)

Workplace if applicable (Enter Retired or N/A if not applicable):

Who's workplace is the above? (leave blank if not applicable)

Name of Other person:

Work Phone # (leave blank if not applicable)

Do you authorize permission for Debonair Campground to release your campsite # to anyone who requests it? * 🛈

Do you consent to receiving E-News Bulletins from Debonair Campground? We respect your privacy and will not give your email address to anyone without your permission. * 🛈

Sign up Here!

If you are not already receiving Debonair E-News Bulletins or are unsure if you are subscribed, or want to add other email addresses, please sign up @ http://eepurl.com/cc0EQL.

Payments

Year of Camping Season this remittance is for: *

Check here only if your Invoice shows a zero balance:

Zero Balance (Payment(s) previously submitted)

Chosen Payment Plan *

If you checked off "Other" Payment Plan, please specify. *

Payments NOT Accepted:
- Post-dated cheques

- PayPal and Credit Card due to the 2.9% surcharge,

- Debit, unless it is PAD (we no longer have a debit/credit card machine at the office).

Post-dated PAD Payments are Welcome.

Payment Type *

Have you used PAD with Debonair Campground in the past? *

Payment payable on * +

Payment Amount *

First Payment is payable on * +

First Payment Amount *

Final Time-Payment payable on: * 🛈 +

2nd Time Payment Amount *

I authorize Debonair Campground to automatically withdraw PAD payments from my account in the specific amount(s) defined on my chosen Payment Plan. *

yes

How do you want to send your PAD information? *

Cheque(s)/Money order *

dropped off at office

mailed

Please mail 3-5 Business days prior to due date to ensure on-time payment. Cheque(s)/Money order mailed on: * 🛈 +

Cheque(s)/Money Order dropped off at the office on: * +

Cash was dropped off at the office on: * +

PAD Transit #

PAD Route / Bank ID

PAD Account #

Name on Account: *

Consent

I, the Policy Holder, have read this year's Campground Policy and agree to abide by it. Click Here to View Policy. *

Answering No to the above question null and voids this form and will prohibit leasing a Seasonal Campsite at Debonair Campground.

Enter Policy Holder's type-written initials to signify knowledge, understanding and acceptance of this form and policy. *

Today's Date * +

Comments (optional):

This form is for online remitting only. Click Here for print version.

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