DIRECT DEBIT FORM

DIRECT DEBIT FORM

By signing this document, I/We authorize: Brighton Technologies Group Pty Ltd with ABN 71 068 606 717 and with Debit User Number 366635, the Debit User, to debit my/our account, detailed in the Schedule below, through the Direct Debit System. I/we must pay you when due under the arrangement between us.
This authority is to remain in force until the final payment date specified or further notice if no final payment date is specified.

The Schedule

1. Financial Institution Names *
2. Financial Institution Address *
3. Account Title *
1. BSB Number *
2. Account Number*
1. Maximum Debit Amount *
2. Frequency of Debits *
3. First Payment Date *
4. Final Payment Date *

Only persons authorised to operate on the account must sign here:

(Please draw your signatures within the grey boxes below)

1. Signature 1 *
2. Full Name *
3. Date *
1. Signature 2
2. Full Name
3. Date

Terms and Conditions

- THIS DIRECT DEBIT ALSO GIVES AUTHORISATION FOR BTG TO DEDUCT PAYMENT FOR MY INITIAL INVOICE WHICH INCLUDES SECURITY DEPOSIT AND FREIGHT. (AND ANY OTHER ADDITIONS AS PER THE INVOICE) - I UNDERSTAND THIS FIRST DEDUCTION WILL DIFFER FROM THE REGULAR MONTHLY PAYMENT DEDUCTION Please note that dishonour fees will apply if funds are not available or other account issues and debit is unsuccessful.

I agree to the Terms & Conditions above

A managed servicewill save you money

A managed service
will save you money