You are about to create a Direct Debit Request for Dynamic Martial Arts

Customer Details

Please enter your details, including the reference number given to you

Debit Arrangement - Instructions to Accept Direct Debits

You may enter one or both of the once off and regular debit arrangements

Once Off Debit

Regular Debits

One Time Setup Fee

$5.50

Bank Account

$1.30

Optional SMS Reminder

$0.28

Visa/Mastercard

2.7% (min $1.19)

Amex

0.00%

Failed Payment Fee

$14.95

Payment Method

Please choose a method of payment. To request a standard paper Direct Debit Authority form to sign and return, please contact the Business

Payments will appear on your statement as Ezidebit

I/We authorize you until further notice to debit my/our account with all amounts which EZIDEBIT (NZ) LIMITED, the registered initiator of Authorization Code 0227418, may initiate by Direct Debit. I/We acknowledge and accept that the bank accepts this authority upon the conditions listed in the terms of this agreement. I confirm that I can operate and have sole authority for the nominated bank account.

Service Agreement

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Approved

2741

07 | 21

DDR Service Agreement(Ver 1.6)

Ezidebit Pty Ltd
|
NZBN: 9429035266310
|
Email: support@ezidebit.co.nz
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Telephone: 0800 394 332
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Fax: (4) 473 6511

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