Lane Cove Electricity Direct Debit Update Details Form

Electricity Direct Debit Account Update Form

Sub Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Sub Time

:HourMinutes
Valued Customer Details
Customer Number
6 digit number located on bill
Full Legal Name

PrefixFirst NameMiddle NameLast Name
Trading Name
ABN/ACN
Unit Number
Address
Suburb
Postcode
State
Country
Mobile Number
E-mail

Debit Arrangements
Payment Method
Please choose a method of payment
Type
Bank Code / BSB
Card Holders Name
Account Number
Account Holder Name
First 4 digits
The rest of the card numbers
Expiry Date
dd/yy
Debit Arrangement Statement

I authorise and request Global Payments Australia 1 Pty Ltd ACN 601 396 543 (Direct Debit User ID number 342190, 342191, 428198) (referred to as “Ezidebit”) to make periodic debits from my nominated account, as specificed, at intervals and amounts as directed by Lane Cove Industrial Estate Utilities Management Rights Pty Ltd and or Australian Utility Rights Pty Ltd as per the Terms and Conditions of the Lane Cove Industrial Estate Utilities Management Rights Pty Ltd agreement and subsequent agreements and as per the Ezidebit DDR Service Agreement (Ver 1.12).

Ezidebit Fees / Charges

One Time Setup Fee $0.00

Bank Account $0.78

SMS Reminder $0.28 per SMS

Visa/Mastercard 3.69%

Amex/Diners 5.5%

Payer Dishonour Fee $21.90

Payments will appear on your statement as UTILITYBILL
Terms & Conditions
Type a question

Further Comments
Should be Empty: