Bankwest Credit Card Direct Debit Request Form

Direct Debit - Credit Card
Request Form
Bankwest, a division of Commonwealth Bank of Australia
ABN 48 123 123 124 AFSL/Australian credit licence 234945
Please complete the form and post it to the below address, or fax it to: 1300 765 515
Bankwest
Reply Paid 64, PERTH WA 6838
Section 1 – Request details
This is a:
New direct debit
Change to an existing direct debit
Cardholder name
Bankwest credit card number
Email address
Residential address
Suburb
State
Postcode
State
Postcode
Postal address (if same as residential address, please write ‘as above’)
Suburb
Section 2 – Account details
I authorise Bankwest, a division of Commonwealth Bank of Australia (User ID No.473, 954 or 138471) to debit my account described below
with the Fixed amount specified below or, if no amount is specified, with any amount which Bankwest may properly debit or charge me
through the direct debit system.
Please ensure your account details are correct by checking them against a recent bank statement.
Name of account to be debited
BSB
Financial institution
Account number
Store/branch
Section 3 – Payment details
Please tick the appropriate box. Note: all repayments will be made on your statement due date unless you select ‘Fixed amount’.
Minimum payment due
Go to Section 5
Statement balance
Go to Section 5
Account balance
Go to Section 5
Fixed amount Amount
Start date of fixed payment
DD/MM/YYYY
$
Go to Section 4
Section 4 – Frequency details (for fixed amount payments only)
Please tick the appropriate box. Note: If you do not select a frequency, we will set the payment to be made on the statement due date.
Weekly
Fortnightly
4 weekly
Monthly
Statement due date
Section 5 – Declaration
By sign below I acknowledge that I have read and that I agree to the terms and conditions of the “Direct Debit Service Agreement”.
Authorised signatory 1
✗
Authorised signatory 2
✗
Date
DD/MM/YYYY
Date
DD/MM/YYYY
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Direct Debit - Credit Card
Request Form
Bankwest, a division of Commonwealth Bank of Australia
ABN 48 123 123 124 AFSL/Australian credit licence 234945
Important Note: This agreement should be retained for your records.
Direct Debit Service Agreement
• Bankwest, a division of Commonwealth Bank of Australia
will arrange for funds to be debited as authorised in the Direct
Debit Request.
• By signing the Direct Debit Request, you warrant and represent
that you are duly authorised to request the debiting of payments
from the account that is described in the Direct Debit Request.
• The Minimum payment, Statement balance and Account balance
payment options are all paid on a monthly basis. Bankwest will
not issue individual confirmation of payments made.
• Bankwest will give you 14 days notice if we propose to vary any
terms of this agreement or the Direct Debit Request.
• If you wish to defer any debit payment or alter any of the details
in your Direct Debit Request, you must either contact the
Bankwest Customer Help Centre on 13 17 19 or write to
Bankwest, Reply Paid 64, Perth WA 6838.
• You may change, stop or defer a debit payment, or terminate
this agreement by providing us with at least 7 days written notice
to Bankwest, Reply Paid 64, Perth WA 6838. You may also call the
Bankwest Customer Help Centre on 13 17 19. All requests for
stops or cancellations may be directed to us or the institution
with which you hold the account that is described in the Direct
Debit Request, which is required to act promptly on your
instructions. In relation to the reference to ‘change’, your financial
institution may ‘change’ your debit payment only to the extent of
advising Bankwest of your new account details.
• Direct Debiting is not available on all accounts at all financial
institutions. If in doubt, you should check with the financial
institution with which you hold the account that is described
in the Direct Debit Request.
• You should ensure that the account details given in the
Direct Debit Request are correct by checking them against a
recent statement from the financial institution at which the
account is held.
• It is your responsibility to have sufficient cleared funds available
in the account to be debited to enable debit payments to be
made in accordance with the Direct Debit Request.
• If a debit payment is returned unpaid, Bankwest may charge you
a fee for each unpaid item.
• If a debit payment falls due on any day which is not a business
day we may take payment up to three days prior to your
payment due date. If you are uncertain as to when a debit will
be processed to your account that is described in the Direct Debit
Request, please contact the financial institution at which the
account is held.
• Except where the terms of the account that is described in the
Direct Debit Request permit disclosure and except to the extent
that disclosure is necessary in order to process debit payments,
investigate and resolve disputed debits, or is otherwise required
or permitted by law, we will keep details of your account and
debit payments confidential.
• If you have any queries concerning debit payments or dispute
any debit payments, you should notify us by calling the
Bankwest Customer Help Centre on 13 17 19. Claims may also be
directed to the institution with which you hold the account that is
described in the Direct Debit Request. Details of the claims
process are set out in the Bankwest Credit Card Account Access
Conditions of Use document.
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