C4U - Direct Debit Agreement

Set Up Your Bank Details
Request & Authorise Collect 4U to arrange through its own financial institution a debit to your nominated account. This debit will be made through the BECS or NPP and will be subject to the T&C of the Direct Debit Service Agreement.
First & Last Name
Mobile Number
E-mail Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of the Business you owe debt to
Select a date to start payments (can't be today)

DayMonthYear
Frequency of payments
Instalment Amount AUD$
Payment to be made from my:
Bank Account Number
Bank Account BSB
Bank Account Details

Street Address

Street Address Line 2
I agree to the T&C and will ensure that sufficient funds are available. I understand transaction surcharges and dishonour fees apply.
Fees & Charges (excl GST)
Once Off account setup fee of $27.70 applies and will be charged on your 1st payment. Each direct debit incurs $1.10 transaction fee. Failed payment $17.70 each.
Should be Empty:

Set Up Your Bank Details