DIRECT DEBIT REQUEST FORM for membership

DIRECT DEBIT REQUEST FORM for membership
REQUEST AND AUTHORITY TO DEBIT THE ACCOUNT OR CREDIT CARD NAMED BELOW TO PAY HOUSING INDUSTRY ASSOCIATION LTD
Please complete all sections marked with x
REQUEST AND AUTHORITY TO DEBIT
x HIA MEMBER NO.
x SURNAME OR COMPANY NAME
x GIVEN NAMES OR ABN
x ADDRESS
x DATE ___ / ___ / ___
PAYMENT METHOD (please select one payment method only – either section A or B below).
(A) DIRECT DEBIT MY FINANCIAL INSTITUTION
(‘you’) request and authorise HIA Ltd User No 263237 to arrange for any amount HIA Ltd may debit or charge you to be debited
through the Bulk Electronic Clearing System from an account held at the financial institution identified below subject to the terms and
conditions of the Direct Debit Request Service Agreement (enclosed) and any further instructions provided below.
x FINANCIAL INSTITUTION NAME
x ADDRESS
x NAME OF ACCOUNT
x BSB NUMBER ___ ___ ___ - ___ ___ ___ (Must be 6 digits)
x ACCOUNT NUMBER ___ ___ ___ ___ ___ ___ ___ ___ ___ (Maximum 9 digits)
*If unsure of BSB and account details please check with your financial institution.
 Regularly debit my financial institution on the first working day of each month
x SIGNATURE
(If signing for a company, sign and print full name and capacity for signing e.g. Director)
OR
(B) DIRECT DEBIT MY CREDIT CARD
x PLEASE DEBIT MY  Visa  Mastercard  Diners
 Amex
 Regularly debit my credit card on the first working day of each month.
If HIA is unable to collect payment on the due date, HIA will make subsequent attempts to collect payment during the month. It is your
responsibility to monitor your account to ensure the correct payments are being deducted.
x CARDHOLDER’S NAME
x CREDIT CARD NO.
   
x CARDHOLDER’S SIGNATURE /
/
/
x EXPIRY DATE
 
/
x DATE ___ / ___ / ___
(C) TERMS AND CONDITIONS
Acknowledgement: By signing this Direct Debit Request you acknowledge having read and understood the terms and conditions governing
the debit arrangements between you and HIA Ltd as set out in this Request and in your Direct Debit Request Service Agreement.
1.It
is your responsibility to have sufficient clear funds available in your account by the due date to permit payment of the Direct Debit.
2.If
the Direct Debit is returned unpaid by the Financial Institution, HIA will contact you to seek further instructions.
3.You
must provide written notice to HIA at the address below should you wish to defer, cancel or alter the direct debit arrangement.
4.If
you cancel the direct debit arrangement before the anniversary of your membership, you will be charged an exit fee equivalent to
the membership fees for the remaining period up to the anniversary, either by continuing direct debits or by separate invoice.
POST TO Housing Industry Association Ltd, 79 Constitution Avenue, Campbell ACT 2612 | T 1300 650 620 | F 02 6248 7294 | E [email protected]
ABN 99 004 631 752
DIRECT DEBIT REQUESTSERVICE AGREEMENT
DEFINITIONS
account means the account held at your financial institution from which we are authorised to arrange for funds to be debited.
agreement means this Direct Debit Request Service Agreement between you and us.
business day means a day other than a Saturday or a Sunday or a public holiday listed throughout Australia.
debit day means the day that payment by you to us is due.
debit payment means a particular transaction where a debit is made.
direct debit request means the Direct Debit Request between us and you.
us or we means Housing Industry Association Limited (‘HIA Ltd’), the Debit User you have authorised by signing a direct debit request.
you means the customer who signed the direct debit request.
your financial institution is the financial institution where you hold the account that you have authorised us to arrange to debit.
1.DEBITING YOUR ACCOUNT
1.1By signing a direct debit request, you have authorised us to arrange for funds to be debited from your account. You should refer to the direct debit request
and this agreement for the terms of the arrangement between both parties.
1.2 We will only arrange for funds to be debited from your account as authorised in the direct debit request.
1.3If the debit day falls on a day that is not a business day, we may direct your financial institution to debit your account on the following business day.
If you are unsure about which day your account has or will be debited you should ask your financial institution.
2.CHANGES BY US
2.1 We may vary any details of this agreement or a direct debit request at any time by giving you at least thirty (30) days’ written notice.
3.CHANGES BY YOU
3.1 Subject to 3.2 and 3.3, you may change the arrangements under a direct debit request by contacting us on 1300 650 620
3.2If you wish to stop or defer a debit payment you must notify us in writing at least fourteen (14) days before the next debit day. This notice should be given to
us in the first instance.
3.3
You may also cancel your authority for us to debit your account at any time by giving us fourteen (14) days notice in writing before the next debit day. This
notice should be given to us in the first instance.
4. YOUR OBLIGATIONS
4.1It is your responsibility to ensure that there are sufficient clear funds available in your account to allow a debit payment to be made in accordance with the
direct debit request.
4.2If there are insufficient clear funds in your account to meet a debit payment:
(a) you may be charged a fee and/or interest by your financial institution;
(b) you may also incur fees or charges imposed or incurred by us; and
(c)you must arrange for 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
that we can process the debit payment.
4.3 You should check your account statement to verify that the amounts debited from your account are correct
4.4If HIA Ltd is liable to pay goods and services tax (“GST”) on a supply made in connection with this agreement, then you agree to pay HIA Ltd on demand an
amount equal to the consideration payable for the supply multiplied by the prevailing GST rate.
5.DISPUTE
5.15.1 If you believe that there has been an error in debiting your account, you should notify us directly on 1300 650 620 and also provide written confirmation
so that the matter can be resolved.
5.2If we conclude as a result of our investigations that your account has been incorrectly debited we will respond to your query by arranging for your financial institution
to adjust your account (including interest and charges) accordingly. We will also notify you in writing of the amount by which your account has been adjusted.
5.3If we conclude as a result of our investigations that your account has not been incorrectly debited we will respond to your query by providing you with
reasons and any evidence for this finding.
5.4Any queries you may have about an error made in debiting your account should be directed to us in the first instance so that we can attempt to resolve the
matter between us and you. If we cannot resolve the matter you can still refer it to your financial institution which will obtain details from you of the disputed
transaction and may lodge a claim on your behalf.
6.ACCOUNTS
You should check:
(a)with your financial institution whether direct debiting is available from your account as direct debiting is not available on all accounts offered by financial institutions.
(b) your account details which you have provided to us are correct by checking them against a recent account statement; and
(c)with your financial institution before completing the direct debit request if you have any queries about how to complete the direct debit request.
7.CONFIDENTIALITY
7.1
We will keep any information (including your account details) in your direct debit request confidential. We will make reasonable efforts to keep any such
information that we have about you secure and to ensure that any of our employees or agents who have access to information about you do not make any
unauthorised use, modification, reproduction or disclosure of that information.
7.2 We will only disclose information that we have about you:
(a) to the extent specifically required by law; or
(b) for the purposes of this agreement (including disclosing information in connection with any query or claim).
8.NOTICE
8.1If you wish to notify us in writing about anything relating to this agreement, please write to: Membership Administration Manager, Housing Industry
Association Ltd, 79 Constitution Avenue, CAMPBELL ACT 2612.
8.2 We will notify you by sending a notice in the ordinary post to the address you have given us in the direct debit request.
8.3 Any notice will be deemed to have been received two business days after it is posted.
ABN 99 004 631 752