Direct Debit Form I/We request Uninor (User ID 314572) to consolidate funds to be debited from my/our nominated account at the financial institution as per schedule below. This debit or charge will be made through the Bulk Electronic Clearing System (BECS) through your account held at the financial institution nominated below and will be subject to the terms and conditions of the Direct Debit Request Service Agreement. New Customer (Telephone #): Existing Customer (Account#): Customer Name: Phone Number: Address: Email: Schedule: Payments will be debited on the due date. If the scheduled date is not a banking day, the debit will take place on the next banking day. Option 1: Bank Account Details Note: Direct Debiting is not available on all accounts. If in doubt, refer to your financial institution. Bank Name: Branch: Account Name: BSB: Account: I/We acknowledge that this Direct Debit facility is governed by the terms of the Direct Debit Service arrangement received from Uninor. 1. Signature(s) 2. Signature(s) and Date and Date Option 2: Credit Card Details Visa Name on the card: Master Card Card number: Expiry date: AMEX Customer's Signature Date ACKNOWLEDGEMENT I/We have read the Direct Debit Service Agreement attached and agree to its terms. I/We request that this Direct Debit Request remain in force until cancelled, deferred or otherwise altered in accordance with the Direct Debit Request Service Agreement. I/We confirm the account/credit card details set out above, are correct and that this Direct Debit Request is signed by the number of authorised signatories required by the financial institution where my/our account is held. Customer's Signature Date Completed Application: Return your completed application by mail to: - PO Box 2505, Taylors Lakes, VIC, 3038. Customer Direct Debit Request (DDR) Service Agreement: This is your Direct Debit Service Agreement with Uninor (314572). It explains what your obligations are when undertaking a Direct Debit arrangement with us. It also details what our obligations are to you as your Direct Debit provider. Please keep this agreement for future reference. It forms part of the terms and conditions of your Direct Debit Request (DDR) and should be read in conjunction with your DDR authorisation. Debiting your account: By signing a Direct Debit Request or by providing us with a valid instruction, 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 us and you. We will only arrange for funds to be debited from your account as authorised in the Direct Debit Request. or We will only arrange for funds to be debited from your account if we have sent to the address nominated by you in the Direct Debit Request, a billing advice which specifies the amount payable by you to us and when it is due. If the debit day falls on a day that is not a banking day, we may direct your financial institution to debit your account on the following banking day. If you are unsure about which day your account has or will be debited you should ask your financial institution. Amendments by us: We may vary any details of this agreement or a Direct Debit Request at any time by giving you at least fourteen (14) days written notice. Amendments by you: You may change, stop or defer a debit payment, or terminate this agreement by providing us with at least seven (7) days notification by writing to: PO Box 2505, Taylors Lakes, VIC, 3038 or by telephoning us on 1300 193 310 during business hours; or arranging it through your financial institution, which is required to act promptly on your instructions. Your obligations: It 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. If there are insufficient clear funds in your account to meet a debit payment: - you may be charged a fee and/or interest by your financial institution; - you may also incur fees or charges imposed or incurred by us; and - 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. * You should check your account statement to verify that the amounts debited from your account are correct. If you believe that there has been an error in debiting your account, you should notify us directly on 1300 193 310 and confirm that notice in writing with us as soon as possible so that we can resolve your query more quickly. Alternatively you can take it up directly with your financial institution. If 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. If 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 in writing. Accounts: You should check: - 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. - your account details which you have provided to us are correct by checking them against a recent account statement; and - with your financial institution before completing the Direct Debit Request if you have any queries about how to complete the Direct Debit Request. Confidentiality: 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. We will only disclose information that we have about you: - to the extent specifically required by law; or - for the purposes of this agreement (including disclosing information in connection with any query or claim). Notice: If you wish to notify us in writing about anything relating to this agreement, you should write to: Uninor Pty Ltd PO Box 2505, Taylors Lakes, VIC, 3038 We will notify you by sending a notice in the ordinary post to the address you have given us in the Direct Debit Request. Any notice will be deemed to have been received on the third banking day after posting. HOW TO CONTACT US Enquiries You can contact us directly or alternatively contact your financial institution. These should be made at least 7 working days prior to the next scheduled drawing date. You may contact us on Phone: 1300 193 310 Email: [email protected] Mail: PO Box 2505, Taylors Lakes, VIC, 3038 Please include your Customer Number in all communication sent.
© Copyright 2018 AnyForm