Direct Debit Request for Fusion Broadband Pty Ltd

Customer Details

Please enter your details, including the reference number given to you by Fusion Broadband Pty Ltd

Person

Business

Your Reference

First Name

Last Name

Mobile No

Address Line 1

Address Line 2

Suburb

State

Postcode

Debit Arrangement

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

Once Off Debit

Debit Amount

Date

Regular Debits

Debit Amount

Starting

Frequency

Duration

Fees / Charges
One Time Setup Fee	$5.50	Visa/Mastercard	0.00%	Optional SMS Reminder	$0.00
Bank Account	$0.00	Amex/Diners	0.00%	Failed Payment Fee	$21.90

Payment Method

Bank Account Details

Bank Code / BSB

Account Number

Account Holder Name

Payments will appear on your statement as FUSION BROADBAND

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

Ezidebit AU Direct Debit Request (DDR) Service Agreement (Version 1.12)

Please print and retain for your records. This Direct Debit Request Service Agreement (Agreement) forms part of the terms and conditions of 
your Direct Debit Request (DDR). 

Debiting Your Account
1.  By agreeing to the DDR you authorise Ezidebit Pty Ltd ACN 096 902 813 (Direct Debit User ID number 342190, 342191, 428198) (referred to as Ezidebit) 
    to make debits to your nominated account. 
2.  The debit will be processed on the next business day after the direct debit date if:
    a. a payment request is received by Ezidebit after Ezidebit's usual cut off time, being 3:00pm Qld time, Monday to Friday;
    b. there is a public or bank holiday on the day when the debit transaction is due to be processed or on any of the following days until the debit is processed.
3.  You authorise Ezidebit to attempt to re-debit any unsuccessful payments. You will also be responsible for any fees and charges applied by your financial 
    institution for each unsuccessful debit attempt together with any collection fees, including but not limited to any solicitor fees and/or collection 
    agent fee as may be incurred by Ezidebit.
4.  Ezidebit may charge you certain fees (including setup, variation, SMS or processing fees) where applicable under your debit arrangement. 
 
Your Responsibilities
5.  It is your responsibility to:
    a. Ensure that your nominated account can accept direct debits;
    b. Ensure that the details on the DDR are correct, and the bank account has been verified against a recent bank statement;
    c. Ensure that all authorised signatories nominated on the financial institution account to be debited authorise the DDR;
    d. Ensure that there are sufficient cleared funds in the nominated account, as a failed payment fee may be charged by Ezidebit if a debit is returned 
       by your financial institution as unpaid;
    e. Advise immediately if the nominated account is transferred or closed or your account details change;
    f. Arrange a suitable payment method if Ezidebit or the Business cancels the drawing arrangements.
   
Cancelling or Changing Direct Debits 
6.  Subject to the terms and conditions of your agreement with the Business, you may cancel, alter or defer the debit arrangement by contacting the Business 
    a reasonable time before the date that the drawing is to be made. 
7.  You authorised Ezidebit to vary the amount of the payments from time to time upon receiving instructions from the Business of a variation provided for 
    within your agreement with the Business. In all other cases, changes to the amounts or dates of a series of direct debits require 14 days' prior notice.
8.  If you believe that there has been an error in debiting your account, you should notify the Business as soon as possible. 
    The Business will notify you of its determination and the amount of any adjustment that will be made to your nominated account (if any). Upon receiving 
    instructions from the Business, Ezidebit will arrange for your financial institution to adjust your nominated account by the applicable amount (if any). 
    Alternatively, you can also contact your financial institution.
9.  You agree that Ezidebit will not be liable for any disputed transactions resulting from the supply or non-supply of goods and/or services by the Business 
    and that all disputes will be directed to the Business (as Ezidebit is acting only as an agent for the Business).
 
Confidentiality 
10. We will keep your account details and direct debit records confidential in accordance with Ezidebit's Privacy Policy, except where the disclosure of 
    certain information to your financial institution is necessary to enable us to act in accordance with your drawing arrangements.
    We may disclose the information in the event of an alleged incorrect or wrongful debit, in relation to a claim, or otherwise as required by law. 
 
Contact
If you wish to contact Ezidebit about anything relating to this Agreement, you should contact: 
Ezidebit
PO Box 3327, Newstead, QLD 4006
Ph: 1300 763 256 Email: support@ezidebit.com.au 
https://www.ezidebit.com/en-au/contact

I agree to the Terms and Conditions of the Direct Debit Request and Service Agreement

Direct Debit Request for Fusion Broadband Pty Ltd

Once Off Debit

Regular Debits

Payment Method

Credit Card Details

Bank Account Details