STEP 1: PLEASE ENTER YOUR BILLER'S ID, NAME OR ABN:
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BILLER DETAILS:
Biller ID:
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Biller Name:
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Biller ABN:
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This Biller is not accepting online DDR authority yet. Please contact your biller to register with Bill Buddy for online DDR authority.

CUSTOMER DETAILS:
this field exceeds the max length allowed If the biller has advised you to put a specific reference number it can be entered here. Often this is your customer number / invoice number / account number / member number / etc.
this field is required {{ label.checkABN }}
this field is over the max length allowed this field is required
this field is over the max length allowed this field is required
this field is required {{ label.checkDOB }}
{{ label.checkLicence }} Please put at least drivers licence here or medicare number next.
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this field is required {{ label.checkEmail }} this field exceeds the max length allowed mandatory for receiving verification email
ADDRESS DETAILS:
this field is required this field exceeds the max length allowed
this field exceeds the max length allowed
this field is required {{ label.checkPostcode }} Please put your postcode here and select a suburb next.
this field is required
CONTACT DETAILS:
{{ label.checkHomePhone }}
{{ label.checkWorkPhone }}
this field is required {{ label.checkMobilePhone }} mandatory for receiving SMS verification code
this field is required {{ label.checkEmergencyPhone }}
this field is required this field exceeds the max length allowed
NOMINATED ACCOUNT:
Select a payment type:
this field is required {{ label.checkBSB }}
this field is required this field exceeds the max length allowed
this field is required {{ label.checkAccountNumber }}
this field is required this field exceeds the max length allowed
this field is required {{ label.checkCardNumber }}
this field is required {{ label.checkCardExpiry }}
this field is required {{ label.checkCardCVV }}
TERMS AND CONDITIONS:

Direct Debit Request Service Agreement

By submitting this Direct Debit Request you acknowledge and agree to the following terms and conditions:

You authorise Bill Buddy to debit your nominated account in the manner specified by your Biller. Your Biller is the organisation providing you with the product or service for which we are debiting your account.

We will provide you with at least 14 30days prior notice in writing if we propose to vary any of the terms of the debit arrangements in place between us. If you stop or cancel your direct debit authority (or an individual payment) as a result of us varying these terms, no penalty will be imposed on you.

You should contact your Biller if you wish to defer or alter any of the debit arrangements.

You will need to advise us in writing if you wish to cancel a Direct Debit Request. Such notice should be delivered to us at least one working day before the due date for payment or as otherwise stipulated in our Terms and Conditions.

If you wish to dispute any Debit Item you should refer to us in the first instance and we will seek to resolve the matter with you. If we cannot resolve the dispute you can contact your financial institution at which your nominated account is held. Your financial institution will then commence a formal claims procedure on your behalf.

Some financial institution accounts do not facilitate direct debits. If you are uncertain, you should check with your financial institution before signing a Direct Debit Request, to ensure that your nominated account is able to receive direct debits through the Bulk Electronic Clearing System.

Before completing the Direct Debit Request, you should check the details of your nominated account against a recent statement from your financial institution, to ensure that your account details are correct.

You agree that it is your responsibility to have sufficient cleared funds in your nominated account by the due date to enable payment of Debit Items in accordance with the directions of your Biller.

We will initiate the Debit Item on the due date as advised by your Biller. If the due date for payment falls on a day which is not a business day in Queensland, then the Debit Item will be processed on the next business day. You should enquire directly with your financial institution if you are uncertain as to when the Debit Item will be processed to your account.

If a Debit Item is returned unpaid by your financial institution, you authorise us to present a further debit for payment. Furthermore you authorise Bill Buddy to debit your account for our Dishonour Charge.

We will ensure the details of your personal records and account details held by us remain confidential. However, if you lodge a claim in relation to an alleged incorrect or wrongful debit, it may be necessary for us to release such information to your financial institution or its representative, or to our financial institution or its representative to enable your claim to be assessed. Further, we will share certain personal information with our contracted agents for statistical purposes only. This does NOT include your bank account or credit card details.

FINAL DECLARATION:

By submitting this Direct Debit Request you acknowledge having read and understood the terms and conditions governing the debit arrangements between you and Bill Buddy Pty Ltd as set out in this Request and in the Direct Debit Request Service Agreement.

Further, you expressly authorise Bill Buddy Pty Ltd to draw any fees under clause 10 of the Direct Debit Request Service Agreement from the account nominated in this form.

I/We have read the Terms and Conditions / Direct Debit Request Service Agreement acknowledge and agree to the same.

I/We acknowedge that any applicable transaction and service fees may be altered by Bill Buddy Pty Ltd with 14 days notice.

I/We am/are the cardholder of the above credit card or the authorised signatory of the above bank account.

I/We authorise the financial institution to release information allowing Bill Buddy Pty Ltd to verify my/our account details.

I/We hereby indemnify and shall keep indemnified Bill Buddy Pty Ltd for debiting my/our account in accordance with the Direct Debit Request Service Agreement.

I/We acknowledge and agree that Bill Buddy Pty Ltd in no way endorses or is responsible for the services provided by your biller/service provider and its role is limited to facilitating payments between you and them by acting on instructions provided by them.

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© 2012 - Bill Buddy Pty Ltd ABN 31 106 055 181