St Patrick's Primary School Port Fairy

Direct Debit Authorisation 2025

**Please note these arrangements are for 2025 only
Request and Authority to debit the account named below to pay St Patrick's Primary School Port Fairy
Surname or Company Name:
Given names or ABN:
(“you”) request and authorise St Patrick’s School – DE User ID No. 366162 to arrange, through its own financial institution, for any amount St Patrick’s School may debit or charge you to be debited through the Bulk Electronic Clearing System from an account held at the financial institution identified below and paid to the Debit User, subject to the terms and conditions of the Direct Debit Request Service Agreement.
Financial Insitution Name:
Account Name:
BSB and Account number:
Acknowledgment

By signing this Direct Debit Request you acknowledge having read and understood the terms and conditions governing the debit arrangements between you and St Patrick’s School as set out in this Request and in your Direct Debit Request Service Agreement.
The First Debit is to be made on:

DayMonthYear
Date
Amount:
Payment Frequency

WeeklyFortnightlyMonthlyTermlyTwice a yearYearly
Tick this box if you want St Patrick's to calculate your payment so the fees are paid in full by 30/11/2025

Calcuate for me
Name

First NameLast Name
Date

DayMonthYear
Date
Signature

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Credit Card Authorisation 2025

**Please note these arrangements are for 2025 only
Request and Authority to debit the account named below to pay St Patrick's Primary School Port Fairy
Surname or Company Name:
Given names or ABN:
(“you”) request and authorise St Patrick’s School – DE User ID No. 366162 to arrange, through its own financial institution, for any amount St Patrick’s School may debit or charge you to be debited through the Bulk Electronic Clearing System from an account held at the financial institution identified below and paid to the Debit User, subject to the terms and conditions of the Credit Card Authorisation Request Service Agreement.
Credit Card Details

MasterCardVISA
Account Name:
Expiry Date:
Card Number:
Card Holder Signature

Powered by Jotform SignClear
Date

DayMonthYear
Date
Acknowledgment

By signing this Credit Card authorisation form you acknowledge having read and understood the terms and conditions governing the debit arrangements between you and St Patrick’s School as set out in this Request Credit Card Authorisation Service Agreement.
The First Credit Card payment is to be made on:

DayMonthYear
Date
Amount:
Payment Frequency

WeeklyFortnightlyMonthlyTermlyTwice a yearYearly
Tick this box if you want St Patrick's to calculate your payment so the fees are paid in full by 30/11/2025

Calcuate for me
Name

First NameLast Name
Signature

Powered by Jotform SignClear
Date

DayMonthYear
Date

Direct Debit Authorisation 2025