Direct Debit Request (DDR)

Customer (Acceptor) To Complete BSB Number and Account Number To Be Debited

To: The Manager (Please print Full Postal Address Clearly for Window Envelope)

Direct Debit Request Customers’ Authority

Name of Customer(s) giving the DDR
Name of Debit User
APCA User ID Number
Name of Sponsor Financial Institution

to arrange for funds to be debited from my/our account at the financial institution identified below and as prescribed below through the Bulk Electronic Clearing Systems (BECS).

This authorization is to remain in force in accordance with the terms described in the Service Agreement

 

Phone 1300 307 159
Fax 1300 881 347
sales@fleetcard.com.au
www.fleetcard.com.au