You are about to create a Direct Debit Request for Imperium Group Fitness

Customer Details

Please enter your details

Debit Arrangement

Please enter your one off payment details

Once Off Debit

One Time Setup Fee

$0.00

Bank Account

$1.57

Optional SMS Reminder

$0.00

Visa/Mastercard

2.49%

Amex

3.2%

Failed Payment Fee

$9.90

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 IGF GYM

I / We authorise Ezidebit Pty Ltd ACN 096 902 813 (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

*This is a preview page only, no payments can be taken on this page.

featureFlag_isInitializeTrue

featureFlag_isOpenTrue