The Direct Debit Authority Form Template – Australia is offered in several formats, including PDF, Word, and Google Docs. Each version is both customizable and print-ready, ensuring it suits your requirements effortlessly.
Direct Debit Authority Form Template – Australia Editable | PrintableSample
1. Account Holder Details 2. Bank Account Details 3. Direct Debit Agreement 4. Frequency of Payments 5. Amount of Payments 6. Commencement Date 7. Cancellation Rights 8. Authorisation
Please read and sign below:
PDF
WORD
Examples
[Customer’s Name]
[Customer’s Address]
[Customer’s Phone]
[Customer’s Email]
[Business Name]
[Business Address]
[Business Phone]
[Business Email]
Account Name: [Account Name]
Account Number: [Account Number]
BSB Number: [BSB Number]
Amount: [Payment Amount]
Frequency: [Payment Frequency] (e.g., Weekly, Monthly)
Commencement Date: [Start Date]
I, the undersigned, hereby authorise [Business Name] to debit the above account on the specified schedule for the payments due.
I understand that I can cancel this direct debit authority by providing written notice to the service provider at least [Notice Period] before the next payment is due.
[Customer’s Signature]
[Customer’s Name]
Full Name: [Customer’s Full Name]
Residential Address: [Address Line 1], [Address Line 2]
Contact Number: [Phone Number]
Email Address: [Email Address]
Business Name: [Business Full Name]
Business Address: [Business Address Line 1], [Business Address Line 2]
Contact Number: [Business Phone Number]
Email Address: [Business Email Address]
Account Holder: [Account Holder Name]
Account Number: [Account Number]
BSB Code: [BSB Code]
Scheduled Amount: [Scheduled Payment Amount]
Debiting Frequency: [Select Frequency: Weekly, Fortnightly, Monthly]
Start Date for Debits: [Start Date]
I authorise [Business Name] to debit my account as explained above until this authority is terminated in accordance with the Terms and Conditions provided.
I have the right to cancel this Direct Debit Authority at any time by notifying [Business Name] at least [Cancellation Notice Period] prior to the next scheduled payment.
[Customer’s Signature]
[Customer’s Name]
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