Direct Debit Authorisation

RETURN THIS FORM BY: Fax (02) 9850 0813 or post Customer Service, TPG, 65 Waterloo Rd, North Ryde, NSW 2113
Enquiries 13 14 23
Direct Debit Authorisation
This agreement is with TPG Internet Pty Ltd (ABN 15 068 383 737).
The direct debit service agreement is issued by TPG Internet Pty Ltd (user
ID 142619).
B ADSL Location Mobile Service Number
Please supply the phone number you want ADSL to be installed
on.
Phone No.
A Direct Debit Service Agreement
1. Our commitment to you
• Where you have a service with TPG Internet that does not include
account usage charges, we will not change the amount or frequency of
drawing arrangements without your prior approval.
• Where you have a service with TPG Internet that does include account
usage charges, the amount and frequency of the drawing arrangements
will be as per the terms and conditions of your service agreement with
us. This may require drawing at various times in the month to cover the
usage charges you have incurred.
• TPG Internet will not disclose your details except where necessary to TPG
Internet’s financial institution and for the purposes of conducting direct
debits with your financial institution.
• TPG Internet will give you at least 14 days notice in writing if there are
changes to the terms of the drawing arrangements.
• For monthly recurring subscription charges, TPG Internet will draw from
your nominated financial institution account normally 7 days prior to the
expiry of your current account’s subscription period. If the due drawing
date is not a business day, TPG Internet will draw on the business day
before or after that date.
2. Your commitment to us
It is your responsibility to:
• Ensure your nominated account can accept direct debits.
• Ensure there are sufficient funds available in the nominated account to
meet each drawing.
(
)
Please supply the mobile phone number you want for your mobile
service.
Mobile
Number
C Your Username
Once you have registered for TPG Broadband or TPG Mobile, we
will send you your username via email, which you should then
enter here.
Username
D Contact Details
First Name
Surname
Address
Suburb
State
Post
Code
• Advise us if the nominated account is transferred or closed, or the
account details change.
• Arrange an alternative payment method acceptable to TPG Internet if
TPG Internet cancels the drawing arrangements.
Phone
(
)
• Ensure that all account holders on the nominated financial institution
account sign the Direct Debit Authorisation.
Mobile
Number
A fee of $10 applies if the financial institution rejects a Direct Debit
transaction.
Email
Available payment methods are by bank account direct debit or by credit
card. If you wish to change your payment method, please contact TPG
customer service.
E Direct Debit Payment Details
Please provide details of the account you wish to debit.
I/We request TPG Internet Pty Ltd (ABN 15 068 383 737) to draw
money from my/our account conducted with:
3. Your rights
If you wish to alter the drawing arrangements for your next direct debit,
please contact TPG Internet at least 7 days prior to the due date of your
service package renewal if your service does not include usage charges.
Otherwise if your service does include usage charges, please contact TPG
Internet immediately to allow this change to be processed as soon as
possible. TPG Internet cannot guarantee that changes can be made in time
for the next direct debit but will strive to achieve this wherever possible.
The drawing arrangements may include:
1. stopping an individual drawing
2. altering the DD Authorisation
Account
Number
Name of
Financial
Institution
3. canceling the DD Authorisation
Branch
Where you consider that a drawing has been initiated incorrectly, you
should first contact TPG Customer Service. If you are not satisfied with
the response, please write to us. Your letter should be marked “Notice of
Complaint” and addressed to: TPG Internet PO Box 1844, Macquarie Centre,
NSW 2113.
Accountholder’s
Name(s)
TPG Internet will respond within 7 days of receiving your letter. TPG
Internet has formal procedures for dealing with a complaint.
You may also direct any disputes, stops or cancellations through your
financial institution.
4. Other information
You should be aware that there are risks involved with providing
instructions and personal information over the internet.
TPG Internet reserves the right to cancel drawing arrangements if drawings
are dishonoured by your financial institution. Your drawing arrangements
are also governed by the terms and conditions of your TPG Internet
account.
-
BSB
Number
Signature
F Agreement and Authorisation
I/We declare that I/We have read, understood and agree to abide by the
terms of the Direct Debit Service Agreement and Terms and Conditions
of my/our TPG account, and verify that I/We are over 18 years of age and
able to enter into legally binding contracts.
Date of
Birth
/
/
/
/
Signature
Full Name
Title
Date
Date of issue: 24/07/13. Replaces: 18/08/11. Page1 of 1