Common Contracts
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ContractAugust 9th, 2011
Direct Debit Request Service Agreement Submit your completed and signed form to Internode by:Direct Debit allows Internode to automatically debit the funds directly from your bank account when your account is due to be paid.The date your payment will be taken will appear on the first page of your invoice. It is your responsibility to ensure sufficient cleared funds are in the nominated debiting account when the payments are to be drawn.If the due date for payment falls on a non-working day or public holiday, the payment will be processed on the next working day.For more information see www.internode.on.net/directdebit Incomplete forms will not be accepted. 1. Customer’s Authority Please type in your responses, answering all relevant questions. If filling in by hand, please print neatly using the spacing provided. *Required fields Name of Internode Account Holder(s)* Date of Birth* I/We* | | | | | | | | | | | | | | | | | | | | | | | | | | | d d / m m / y y y yName of Debit User ACPA Use
