DIRECT DEBIT REQUEST (DDR) Request and Authority to debit the account named below to pay The Scots School Albury. The Scots School Albury, 393 Perry Street (PMB 6006, AMDC) Albury NSW 2640 www.scotsalbury.nsw.edu.au P: 02 6022 0039 F: 02 6041 3210 E: [email protected] ABN: 40 958 401 920 CRICOS: 02274B The Scots School Albury complies with the Australian Privacy Principles as set out in the Commonwealth Privacy Act (2014) Request and Authority to debit Surname or Company name __________________________________________________________ Given name or ABN ____________________________________ (“you”) Parent Code ___________ request and authorise The Scots School Albury to arrange for any amount The Scots School Albury may debit or charge you to be debited through the Bulk Electronic Clearing System from an account held at the financial institution identified below subject to the terms and conditions of the Direct Debit Request Service Agreement (and any further instructions provided below). Name and address of Financial Institution of Bank Account Financial institution name ____________________________________________________________ Address ___________________________________________________________________________ ___________________________________________________________________________ Select Bank Account or Credit Card to be debited and provide details o BANK ACCOUNT DIRECT DEBITS Name of Bank account/Cardholder _________________________________________________ BSB number ___ ___ ___ ___ ___ ___ Account Number ________________________ o CREDIT CARD DIRECT DEBITS Credit Card Number ___ ___ ___ ___/ ___ ___ ___ ___/ ___ ___ ___ ___ /___ ___ ___ ___ Expiry date ____ ____ / ____ ____ Card Type: VISA, MasterCard, AMEX, Diners (please circle) Acknowledgment By signing this Direct Debit Request you acknowledge having read and understood the terms and conditions governing the debit arrangements between you and The Scots School Albury as set out in this Request and in your Westpac Direct Debit Request (DDR) Service Agreement. I/We have read the enclosed information and wish to pay our fees and extras estimate account by Direct Debit. It is understood that the School undertakes to debit ONLY the amount that has been authorised by the family in accordance with the agreed Fee Payment Plan. Signature __________________________________ Name (print) ___________________________ (If signing for a company, sign and print full name and capacity for signing, eg, director.) Address ________________________________________________________________________ ________________________________________________________________________ Email ________________________________________________________________________ Date ___/___/_____ Please return by mail, fax or email to the Business Office (contact details below). A Fee Payment Plan will be posted to you together with the Westpac Direct Debit Request (DDR) form and the Westpac Customer Direct Debit Request (DDR) Service Agreement.

DIRECT DEBIT REQUEST (DDR) - Scots School · PDF file · 2017-01-18Title: Microsoft Word - The Scots School Albury - Direct Debit.docx Created Date: 1/18/2017 3:51:40 AM

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Page 1: DIRECT DEBIT REQUEST (DDR) - Scots School · PDF file · 2017-01-18Title: Microsoft Word - The Scots School Albury - Direct Debit.docx Created Date: 1/18/2017 3:51:40 AM

DIRECT DEBIT REQUEST (DDR)Request and Authority to debit the account named below to pay The Scots School Albury.

TheScotsSchoolAlbury,393PerryStreet(PMB6006,AMDC)AlburyNSW2640www.scotsalbury.nsw.edu.auP:0260220039F:0260413210E:[email protected]:40958401920CRICOS:02274B

TheScotsSchoolAlburycomplieswiththeAustralianPrivacyPrinciplesassetoutintheCommonwealthPrivacyAct(2014)

RequestandAuthoritytodebit

SurnameorCompanyname__________________________________________________________

GivennameorABN____________________________________(“you”)ParentCode___________requestandauthoriseTheScotsSchoolAlburytoarrangeforanyamountTheScotsSchoolAlburymaydebitorchargeyoutobedebitedthroughtheBulkElectronicClearingSystemfromanaccountheldatthefinancialinstitutionidentifiedbelowsubjecttothetermsandconditionsoftheDirectDebitRequestServiceAgreement(andanyfurtherinstructionsprovidedbelow).

NameandaddressofFinancialInstitutionofBankAccount

Financialinstitutionname____________________________________________________________

Address___________________________________________________________________________

___________________________________________________________________________

SelectBankAccountorCreditCardtobedebitedandprovidedetails

o BANKACCOUNTDIRECTDEBITS

NameofBankaccount/Cardholder_________________________________________________

BSBnumber __________________ AccountNumber________________________

o CREDITCARDDIRECTDEBITS

CreditCardNumber ____________/____________/____________/____________

Expirydate ________/________ CardType:VISA,MasterCard,AMEX,Diners (pleasecircle)

Acknowledgment BysigningthisDirectDebitRequestyouacknowledgehavingreadandunderstoodthetermsandconditionsgoverningthedebitarrangementsbetweenyouandTheScotsSchoolAlburyassetoutinthisRequestandinyourWestpacDirectDebitRequest(DDR)ServiceAgreement.

I/WehavereadtheenclosedinformationandwishtopayourfeesandextrasestimateaccountbyDirectDebit.

ItisunderstoodthattheSchoolundertakestodebitONLYtheamountthathasbeenauthorisedbythefamilyinaccordancewiththeagreedFeePaymentPlan.

Signature __________________________________Name(print)___________________________ (Ifsigningforacompany,signandprintfullnameandcapacityforsigning,eg,director.)

Address ________________________________________________________________________

________________________________________________________________________

Email ________________________________________________________________________

Date ___/___/_____

Pleasereturnbymail,faxoremailtotheBusinessOffice(contactdetailsbelow).AFeePaymentPlanwillbepostedtoyoutogetherwiththeWestpacDirectDebitRequest(DDR)formandtheWestpacCustomerDirectDebitRequest(DDR)ServiceAgreement.