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Direct Debit Request Form


DIRECT DEBIT REQUEST


COMPANY NAME: Commanding Communications PTY LTD t/as Business Technology Centre
ADDRESS: P O Box 4252, KIRWAN QLD 4817
CONTACT DETAILS: accounts@businesstc.com.au


Request and Authority to debit the account named below to pay

Business Technology Centre


Request and Authority to debit

Your Surname or company name  
Your Given names or ABN /ARBN “You”
request and authorise Business Technology Centre to arrange, through its own financial institution, a debit to
Your nominated account any amount Business Technology Centre, has deemed payable by You.
This debit or charge will be made through the Bulk Electronic Clearing System (BECS) from Your account held
at the financial institution You have nominated below and will be subject to the terms and conditions of the
Direct Debit Request Service Agreement.

Insert the name and address of financial institution at which account is held

Financial institution name  
Address   

Insert details of account to be Debited

Name/s on account  
BSB number (Must be 6 Digits) –   
Account number  

Acknowledgment

By signing and/or providing us with a valid instruction in respect to Your Direct Debit Request,
You have understood and agreed to the terms and conditions governing the debit arrangements between
You and Business Technology Centre as set out in this Request and in Your Direct Debit Request Service Agreement

Insert your address:   
(If signing for a company, sign and print full name and capacity for signing eg. director)
Your full name:    
Your position in the company or business:    


 

Leave this empty:

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Signature Certificate
Document name: Direct Debit Request Form
Unique Document ID: 40f535e52ff5c7db30df88290d754afebbb706d7
Timestamp Audit
2016-08-04 04:35:55 AESTDirect Debit Request Form Uploaded by Josh Rushton - sales@businesstc.com.au IP 174.108.62.21