Direct Debit Request (DDR) Please enable JavaScript in your browser to complete this form.Fleet Card Account NumberCompany NameABN #Customer (Acceptor) To Complete BSB Number and Account Number To Be DebitedBSB NumberAccount NumberTo: The Manager (Please print Full Postal Address Clearly for Window Envelope)Bank BranchAddressAddress Line 1CityState / Province / RegionDirect Debit Request Customers’ AuthorityI/WeName of Customer(s) giving the DDRAuthorise youName of Debit UserAPCA User ID NumberAPCA User ID NumberAndName of Sponsor Financial Institutionto 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 AgreementSignatureClear SignatureDateSignatureClear SignatureDate I have read Direct Debit Request Service Agreement *I have read Direct Debit Request Service AgreementThis agreement, in conjunction with the Direct Debit Request (“DDR”), sets out the terms on which you (the person who, or entity which, has signed or authorized by other means the DDR) have authorized Business Fuel Cards Pty Ltd ACN 161 721 106 (“we”, “us” or “our”) to arrange for amounts owing to us to be debited from your account at your financial institution specified on your DDR (“account”). 1. Debiting arrangements –The details of your debiting arrangements are shown in your DDR. By you signing or otherwise authorizing the DDR, you authorize us to debit the amounts that become payable to us from your account. This agreement will remain in force until explicitly cancelled by either you or us. We will only arrange for funds to be debited from your account if we have sent to the address stated on the DDR a billing advice specifying the amount payable by you to us and when it is due. If a debit date falls on a day which is not a business day, the debit will be made on the next business day. If you are unsure which day your account will be debited you can contact your financial institution or phone 1300 881 246. We will make reasonable efforts to keep your direct debit records and account details confidential and secure, so that any of our employees or agents who have access to information about you do not make any unauthorized use, modification, reproduction or disclosure of that information, except where the disclosure of certain information is required by law or is necessary for purposes of this agreement. 2. Amendments – We may vary any details of this agreement at any time after giving you 14 days written notice. You may stop, defer, cancel and in some instances change the payments under the DDR, by notifying us in writing at least 14 business days before the next debit date, either by writing to: Business Fuel Cards Pty Ltd, GPO Box 3852, Sydney, NSW, 2001; or arranging through your financial institution; or phoning us on 1300 881 246. 3. Disputes – If you consider that there has been an error in debiting your account, you should call us on 1300 881 246 in the first instance and follow up with written notification. Alternatively, you can still refer the matter to your financial institution. Where we find an error has occurred we will arrange with your financial institution to adjust your account (including interest and charges) accordingly and notify you in writing the amount adjusted. Where we find an error has not occurred, we will provide you with reasons and evidence of our finding in writing. 4. Your responsibilities – It is your responsibility to ensure that your financial institution accepts direct debits on your nominated account (direct debiting may not be available on all accounts), and to ensure that there are sufficient funds in your nominated account by the due date to enable debits to be made by us. If debiting is unsuccessful due to insufficient funds, you may be charged a fee by us and your financial institution and you must arrange the debit payment to be made by another method or arrange for sufficient clear funds to be in your account by an agreed time so we can process the debit payment. You should check your account statement to verify the amounts debited from your account are correct. You should check that your account details on your DDR are correct and the authority given to us to debit your nominated account is consistent with the account authority or signing instructions held by your financial institution for that account. You must advise us if your nominated account is transferred, closed or any other account details change, and arrange a suitable alternative payment method if your debiting arrangements are cancelled 4. Notification – If you wish to notify us in writing about anything relating to this agreement, you should write to Business Fuel Cards Pty Ltd, GPO Box 3852,Sydney NSW 2001. If we wish to notify you about anything relating to this agreement, we will send a notice in the ordinary post to the address you have given us in the DDR. Any notice will be deemed to have been received on the third banking day after posting.Submit Phone 1300 307 159 Fax 1300 881 347 sales@fleetcard.com.au www.fleetcard.com.au