Direct Debit Form

Oasis Otters - Direct Debit Request

Oasis Otters Swimming Club INC C/O Dandenong Oasis Corner Heatherton Road & Cleeland Street Dandenong, Vic 3175 Email: oasisotters@gmail.com
Request and Authority to debit the account named below to pay

Oasis Otters Swimming Club INC
Request and Authority to debit
Name*

First NameLast Name
Email*
example@example.com
Request and authorise Oasis Otters Swimming Club INC. 479679 to arrange, through its own financial institution, a debit to your nominated account any amount Oasis Otters Swimming Club INC, 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 Services Agreement.
Bank Details
Financial Institution Name
Financial Institution Address:

Street Address

Street Address Line 2

CityState

Post Code
Account Details
Name on Account:*
Secondary Name on Account:
BSB Number: *
Account Number:*
First Training Date:*

DayMonthYear
Acknowledgement
By signing and/or providing us with a valid instruction in respect to your Direct Debit Request you have understood and agreed to the club's squad training fees as well as the terms and conditions governing the debit arrangements between you and Oasis Otters Swimming Club INC as set out in this Request and in your Direct Debit Request Services Agreement.
Signature*

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Second Account Signatory*

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Date

MonthDayYear
Date
Should be Empty:

Oasis Otters - Direct Debit Request

Request and Authority to debit

Bank Details

Account Details

Acknowledgement