You are about to create a Direct Debit Request for Crossfit CT

Customer Details

Please enter your details

Debit Arrangement

Please enter your regular debit arrangement

Regular Debits

One Time Setup Fee

$0.00

Bank Account

$0.00

Optional SMS Reminder

$0.00

Visa/Mastercard

0.00%

Amex/Diners

0.00%

Failed Payment Fee

$14.80

Payment Method

Please choose a method of payment

Payments will appear on your statement as CROSSFITCT

I / We authorise Global Payments Australia 1 Pty Ltd ACN 601 396 543 (User ID No 342190, 342191, 428198) to debit my/our account at the Financial Institution identified above through the Bulk Electronic Clearing System (BECS) in accordance with this Direct Debit Request.

Service Agreement

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