Ezidebit - Electronic Direct Debit Request

Company Trading Name

Application:

Business

Personal

Surname:

Given Name:

Your Ref:

Mobile Ph:

I authorise Ezidebit to remind me of upcoming debits via SMS.

Email:

Address:

Suburb:

State:

Postcode:

Debit Arrangement / Payment Details

I authorise and request the debit user detailed below to debit payments from my nominated account, as specified below, at intervals and amounts as per the Terms and Conditions of the agreement and subsequent agreements.

Once Only Debit	Debit: $	Date:

Regular Debits	Debit: $	Start:
	Frequency:
	Duration:

Choose Your Payment Method

Debit from Credit Card

VISA

Mastercard

American Express

Diners Club

Card Number:

Expiry Date:

Card holder Name:

By signing this form, I / We authorise Ezidebit Pty Ltd, acting on behalf of the business to debit payments from my specified credit card above, and I / we acknowledge that Ezidebit will appear as the business name on my credit card statement.

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 Service Agreement		Date
This Authorisation is to remain in force in accordance with the Terms and Conditions on this page, the provided Service Agreement, and I/we have read and understand the same.

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