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    Img 20200323 0001

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    unagirl33

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    Img 20200323 0001

    Uploaded by

    unagirl33
    6 views1 page

    Original Title

    IMG_20200323_0001

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    6 views1 page

    Img 20200323 0001

    Uploaded by

    unagirl33

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Direct Debit Request

    #r*r,i#d;:,,""
    Request and Authority to debit the account named below to pay
    LAKES GRAMMAR - An AucuCau SCnOOI
    ""f
    Request and Authority Your surname or company nt*" ( i'-{Fi{
    to debit
    Your Given names or ABN/ARBN f&f i Q L I G.t U C 4
    .'oyou"

    request and authorise LAKE$ GRAMMAR - AN ANGLIcnn Scroor, 374704 to


    anange, through its own financial institution, a debit to your nominated account
    any amount LAKES GRAMMAR - AN ANGLTCAN ScHooL, has deemed payable
    by you.

    This debit or charge will be made through the Bulk Electronic Clearing System
    (BECS) from your account held at the financial institution you have nominated
    below and will be subject to the terms and sonditions of the Direct Debit Request
    Service Agreement.

    Insert the name and f inancial institution name € CRCE


    -vJ
    address of financial
    Address
    institution at which
    account is held

    Insert details of Name/s on account a cftr<A-c4


    account to be debited
    BSB number (Mu$ be 6 Disib)

    Account number rj1rt-r8 14 lri \tot?r


    Acknowledgment By signing and/or providing us with a valid instruction in respect to yoar Direct
    Debit Request, you have understood and agreed to the terms and conditions
    governing the debit arrangements between you and LAKES GRAMMAR - AN
    ANGLTcAN Sctrool as set out in this Request and in your Direct Debit Request
    SeryiceAgreement. r a_
    f :/ /-./\ \/
    "/'
    Payment Details d The first debit of gil--iufA{-ade on ----- 1:-.---12020 and at
    weekly/fu,rt*ightlyhonthly intervals after that.

    fln,t,\ fl /
    Insert your signature
    Signature
    and address
    (If signing for a , sign and print full name and capacity for signing
    eg. director)

    Address
    d
    n
    0A-/O+l CuQf
    ,, Q(nc r{s/ &a
    Date il'rs t}oaQ
    Version Control (05i05)

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