Common Contracts
1 similar Direct Debit Request contracts
Direct Debit RequestDirect Debit Request • July 31st, 2021
Your Details Existing Account No (CIDN): Title: First Name: Last Name: Choose your Payment Method:☐ Debit from Debit/Credit Card ☐ Debit from Bank, Building Society or Credit Union Account Debit from Debit/Credit Card ☐ VISA/MasterCard ☐ American Express (3% Surcharge Applies) Card Number: Expiry Date: / CVV#: Name of Cardholder: Debit from Bank, Building Society or Credit Union Account Financial Institution: Branch: BSB Number: / Account Number Account Holder Name: DDR Service Agreement▪ I/We hereby authorise Telecom Billing ABN 42 144 043 863 (herein referred to as "Telecom Billing") to make periodic debits on behalf of Us (herein referred to as "the Business").▪ I/We acknowledge that Telecom Billing is acting as a Direct Debit Agent for the Business and that Telecom Billing does not provide any goods or services (other than the direct debit collection services to me/us for the Business pursuant to the Direct Debit Request and this DDR Service Agreement) and has no express or i
