Direct Debit Request for 123 Group Pty Ltd - Abn 79 108 640 544

Customer Details
Please enter your details, including the reference number given to you by 123 Group Pty Ltd - Abn 79 108 640 544
Debit Arrangement
I authorise and request the debit user detailed below to debit payments from my nominated account, as specified below, at intervals and amounts as directed by 123 Group Pty Ltd - Abn 79 108 640 544 as per the Terms and Conditions of the 123 Group Pty Ltd - Abn 79 108 640 544 agreement and subsequent agreements.
Fees / Charges
One Time Setup Fee $0.00 Visa/Mastercard 2.2% (min $1.10) Optional SMS Reminder $0.00
Bank Account $0.00 Amex/Diners 4.4% (min $1.10) Failed Payment Fee $14.80
Payment Method
Please choose a method of payment.

Payment Method

Payments will appear on your statement as 123 GROUP P/L

I / We authorise Ezidebit Pty Ltd ACN 096 902 813 (User ID No 165969) to debit my/our account at the Financial Institution identified above through the Bulk Electronic Clearing System (BECS) in accordance with the Debit Arrangement stated above and this Direct Debit Request and as per the Ezidebit DDR Service Agreement (Ver 1.9) provided.

Service Agreement