Direct Debit Request (Rates) Form

Home Residents Rates & Valuations Direct Debit Request (Rates) Form

Direct Debit Request (Rates) Form

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Direct Debit Request (Rates) Form
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Direct Debit Request (Rates) Form

Customer’s Authority

I/We
Name of customer/s giving the DDR(Required)
Address of customer/s giving the DDR

Details of the account to be debited

Note: Direct debiting is not available on the full range of accounts. If in doubt, please refer to your bank/financial institution. Processing via a credit card is not available.

Request and authorise the Benalla Rural City Council (User ID: 209357) until further notice in writing, to arrange for funds to be debited through the Bulk Electronic Clearing System (BECS) from my/our account at the Financial Institution identified below as instructed by me/us or any other amounts as instructed or authorised to be debited in accordance with the terms and conditions of the Direct Debit Request Service Agreement (DDRSA) as amended from time to time.

Payment Details

This authority allows the debiting of amounts payable by the customer under the agreement between the customer and the Benalla Rural City Council.
Frequency(Required)
DD slash MM slash YYYY
Note: Payments are processed on Friday only

Customer Authorisation

If in joint names both signatures may be required.
Consent
Clear Signature
Clear Signature