Direct Debit Request Form

Westpac Banking Corporation ABN 33 007 457 141
AFSL and Australian credit licence 233714
Easy Pay – making repayments as easy as 1 - 2 - 3
... it's time saving, convenient and easy.
111–1111111–111
Direct Debit Request
Form PD-C
Form of request for debiting amounts from a nominated account through the Bulk Electronic Clearing System.
Your Details
First name
Last name
Company name
Contact number
(
)
ABN/ACN
Your Facility
Details of your facility which you would like to pay via direct debit:
Contract number
111–1111111–111
If you’re unsure of your contract number, call the Business Finance Operations Centre on 1300 360 322
Bank Account To Be Debited
Please provide details of the account which you’d like your payments to be debited:
Account name(s)
BSB
Account number
Name of financial institution
Your instructions to Westpac Banking Corporation ABN 33 007 457 141
Name
I/We:
• request you until further notice in writing to debit to my/our nominated account referred to above amounts which Westpac Banking
Corporation ABN 33 007 457 141 (user ID188154) may debit or charge me/us through the Direct Debit System under my/our Facility
referred to above; and
• accept the terms of the Direct Debit Request Service Agreement.
Please note: If the debiting account is in joint names then both account holders must sign below.
Signature of customer(s)
✗
Print name of Signatory 1
Date
✗
/
/ 20
Print name of Signatory 2
Office Use Only
Name of Bank
Name of Account
Bank/State/Branch No.
Account No.
Coded by
Westpac Banking Corporation
Westpac COPY
Please return the form to your nearest Westpac Branch or fax to Equipment Finance Ops, Customer Liaison Team, Fax No. 02 9995 8048
Bank Use Only
Fax completed form to Equipment Finance Ops, Customer Liaison Team 02 9995 8048
Or mail to IBN 20 032890CW

Page 1 of 3
AGC5966 (04/12) 271291  Intranet
Westpac Banking Corporation ABN 33 007 457 141
Easy Pay – making repayments as easy as 1 - 2 - 3
... it's time saving, convenient and easy.
111–1111111–111
Direct Debit Request
Form PD-C
Form of request for debiting amounts from a nominated account through the Bulk Electronic Clearing System.
Your Details
First name
Last name
Company name
Contact number
(
)
ABN/ACN
Your Facility
Details of your facility which you would like to pay via direct debit:
Contract number
111–1111111–111
If you’re unsure of your contract number, call the Business Finance Operations Centre on 1300 360 322
Bank Account To Be Debited
Please provide details of the account which you’d like your payments to be debited:
Account name(s)
BSB
Account number
Name of financial institution
Your instructions to Westpac Banking Corporation ABN 33 007 457 141
Name
I/We:
• request you until further notice in writing to debit to my/our nominated account referred to above amounts which Westpac Banking
Corporation ABN 33 007 457 141 (user ID188154) may debit or charge me/us through the Direct Debit System under my/our Facility
referred to above; and
• accept the terms of the Direct Debit Request Service Agreement.
Please note: If the debiting account is in joint names then both account holders must sign below.
Signature of customer(s)
✗
Print name of Signatory 1
Date
✗
/
/ 20
Print name of Signatory 2
Office Use Only
Name of Bank
Name of Account
Bank/State/Branch No.
Account No.
Coded by
Westpac Banking Corporation
Customer COPY
Please return the form to your nearest Westpac Branch or fax to Equipment Finance Ops, Customer Liaison Team, Fax No. 02 9995 8048
Bank Use Only
Fax completed form to Equipment Finance Ops, Customer Liaison Team 02 9995 8048
Or mail to IBN 20 032890CW

Page 2 of 3
AGC5966 (04/12) 271291  Intranet
Direct Debit Request Service Agreement
This Direct Debit Request Service Agreement is issued by Westpac Banking Corporation ABN 33 007 457 141 (“the Bank”) and sets out
your rights and responsibilities when making payments due under your facility by direct debit.
1. Our commitment to you
a) The Bank will debit your nominated financial institution account (“nominated account”) in accordance with your Direct Debit Request
(“DDR”).
b) The Bank will give you at least 14 days’ notice if the Bank needs to change your direct debit arrangements including changes to the
monthly payment.
c) The Bank will keep information relating to your nominated account confidential, except where required for the purpose of conducting
direct debits with your financial institution or in connection with claims made on the Bank relating to an alleged incorrect debit.
2. Your commitment to us
It is your responsibility to:
• ensure your nominated account can accept direct debits as direct debiting is not available on all accounts. If you are uncertain about this,
please check with the financial institution where your nominated account is held;
• check your nominated account details against a recent statement before completing the DDR;
• ensure there are sufficient clear funds available in the nominated account to allow payments to be made in accordance with your DDR;
• advise the Bank as soon as possible if the nominated account is transferred or closed, or the account details change;
• arrange an alternate method of payment if the Bank cancels your direct debit arrangements for any reason; and
• ensure that all account holders on the nominated account sign the DDR.
3. Your Rights
You need to give the Bank at least 7 days’ notice before your next scheduled payment for any of the following:
• stopping an individual payment;
• deferring a payment;
• suspending future payments;
• altering the DDR; or
• cancelling the payments completely.
You can make all of these changes by calling the Business Finance Operations Centre on 1300 360 322. You may also stop an individual
payment or cancel your DDR by contacting the financial institution where your nominated account is held.
4. Other information
a) If the due date for a payment falls on a weekend or national public holiday, the Bank will automatically debit your nominated account on
the next business day. If you are uncertain as to when a debit will be processed from your nominated account, please check the financial
institution where your nominated account is held.
b) The Bank reserves the right to ask that instructions from you to stop or in any way alter the payment details is in a written form.
c) If your financial institution cannot withdraw the nominated amount from your nominated account (for example, there’s not enough money
in your account), they may dishonour the withdrawal. Please check the terms and conditions of your nominated account to see whether
dishonour fees apply.
d) If you believe there has been an error in debiting your nominated account, please contact the Business Finance Operations Centre as
soon as possible on 1300 360 322.
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AGC5966 (04/12) 271291  Intranet