Direct Debit Payment Authority

*- indicates required field.

Customer details

Or full contact name if completing for a business or trust.
Or full contact name if completing for a business or trust.

To: The Bank Manager

AUTHORITY TO ACCEPT DIRECT DEBITS (Not to operate as an assignment or agreement)

AUTHORISATION CODE 0112495

 
Type your full legal name (typing your legal name is acceptable by online application). This will also indicate to us that you have full authority on the account. If required a hard copy of this document can be made available for signing.
Type your full legal name (typing your legal name is acceptable by online application). This will also indicate to us that you have full authority on the account. If required a hard copy of this document can be made available for signing.
Type your full legal name (typing your legal name is acceptable by online application). This will also indicate to us that you have full authority on the account.
Type your full legal name (typing your legal name is acceptable by online application). This will also indicate to us that you have full authority on the account.

Please note this form will be lodged with Council and we will lodge it with your bank. Following acceptance by your bank, Council will advise you of your Direct Debit amounts and due dates - that is why there is no amount on the form.

Your session is about to time out.

You will lose any unsaved data.

Click "Continue" to extend your session.

Unfortunately, an error has occurred when processing this form. Please click "OK" to reload.