Request to Cancel Direct Debit

Page 1 of 1     1. Name:*         2. Date:*   mm/dd/yyyy       3. Home Phone Number:*         4. Work Phone Number:         5. Parkside Address:*         6. Final month of debit:*           I hereby request Parkside Condominium to cancel debit entries in the amount of my monthly condominium fee from my bank account. This electronic notification will serve as termination of the previous authorization agreement with Parkside. The notification must be given by the fifteenth day of the previous month to enable a resonable opportunity to process the termination request. For example, to terminate the agreement for the month of December, I must notify Parkside no later than November 15th.       7. E-mail Address:*           By supplying my e-mail address and submitting this request electronically I certify that I do want to cancel the direct debit of my condominium fees.