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Account Details
Organisation Type
*
Private Company (Pty Ltd)
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Public Company
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Incorporated Association
Trust/Trustee
Legal Organisation Name
*
ABN / ACN
*
Trading Name
*
Phone
*
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*
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*
Website
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*
Street Address
Address Line 2
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Virgin Islands, U.S.
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Country
Billing Address same as Street Address
Yes
No
Billing Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Primary Contact
Primary contact is the party responsible for the account. e.g. Company Director, Proprietor.
Name
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Last
Date of Birth
*
DD slash MM slash YYYY
Drivers License No
*
State
*
VIC
QLD
SA
TAS
NSW
ACT
WA
NT
Telephone No.
*
Mobile
Email
*
Position
*
Billing Contact
Same as Director / Proprietor
Yes
No
Billing Contact Details
Name
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Last
Telephone / Mobile
Email
*
Position
Date of Birth
MM slash DD slash YYYY
Technical Contact
Same as Director / Proprietor
Yes
No
Technical Contact Details
Name
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Last
Position
Email
*
Mobile
Date of Birth
MM slash DD slash YYYY
Payment Method
Payment Method
*
Direct Debit
Account (BPAY)
Direct Debit
Bank
*
Allied Members Credit Union Ltd
AMP Bank Ltd
Arab Bank Australia Limited
Australia and New Zealand Banking Group Limited (ANZ)
Australian Central Credit Union Ltd (trading as People's Choice Credit Union)
Australian Defence Credit Union Limited
AWA Credit Union Limited
B & E Ltd
Bananacoast Community Credit Union Ltd
Bank of China (Australia) Limited
Bank of Queensland Limited
Bank of Sydney Ltd
Bankstown City Credit Union Ltd
Bendigo and Adelaide Bank Limited
Berrima District Credit Union Ltd
Big Sky Building Society Limited
CAPE Credit Union Limited
Central Murray Credit Union Limited
Central West Credit Union Limited
Circle Credit Co-operative Limited
Citigroup Pty Limited
Coastline Credit Union Limited
Collie Miners Credit Union Ltd
Commonwealth Bank of Australia
Community Alliance Credit Union Limited
Community CPS Australia Limited (trading as Beyond Bank Australia)
Community First Credit Union Limited
Community Mutual Ltd
Country First Credit Union Ltd
Credit Union Australia Ltd
Credit Union SA Ltd
Defence Bank Limited
Dnister Ukrainian Credit Co-operative Limited
ECU Australia Ltd
EECU Limited
Encompass Credit Union Limited
Family First Credit Union Limited
Fire Brigades Employees' Credit Union Limited
Fire Service Credit Union Limited
Firefighters & Affiliates Credit Co-operative Limited
First Choice Credit Union Ltd
First Option Credit Union Limited
Ford Co-operative Credit Society Limited
Gateway Credit Union Ltd
Goldfields Money Limited
Goulburn Murray Credit Union Co-operative Limited
Greater Building Society Ltd
Heritage Bank Limited
Heritage Isle Credit Union Limited
Holiday Coast Credit Union Ltd
Horizon Credit Union Ltd
HSBC Bank Australia Limited
Hume Building Society Ltd
Hunter United Employees' Credit Union Limited
IMB Ltd
ING Direct (the trading name of ING Bank (Australia) Limited)
Intech Credit Union Limited
Investec Bank (Australia) Limited
Laboratories Credit Union Limited
Latvian Australian Credit Co-operative Society Limited
Lithuanian Co-operative Credit Society "Talka" Limited
Lysaght Credit Union Ltd
MacArthur Credit Union Ltd
Macquarie Bank Limited
Macquarie Credit Union Limited
Maitland Mutual Building Society Limited
Manly Warringah Credit Union Limited
Maritime, Mining & Power Credit Union Limited
MCU Ltd
mecu Limited (trading as bankmecu)
Members Equity Bank Pty Limited
My Credit Union Limited
MyState Financial Limited
National Australia Bank Limited (NAB)
Newcastle Permanent Building Society Limited
Newcom Colliery Employees Credit Union Ltd
Northern Inland Credit Union Limited
Nova Credit Union Limited
Old Gold Credit Union Co-operative Limited
Orange Credit Union Limited
Police & Nurses Limited (trading as P&N Bank)
Police Bank Ltd
Police Credit Union Limited
Police Financial Services Limited (trading as BankVic)
Pulse Credit Union Limited
Qantas Staff Credit Union Limited
QT Mutual Bank Limited
Quay Credit Union Ltd
Queensland Country Credit Union Limited
Queensland Police Credit Union Limited
Queensland Professional Credit Union Ltd
Queenslanders Credit Union Limited
Rabobank Australia Limited
Railways Credit Union Limited
Rural Bank Limited (a subsidiary of Bendigo and Adelaide Bank Limited)
Select Credit Union Limited
Service One Credit Union Limited
SGE Credit Union Limited
Shell Employees' Credit Union Limited
South West Slopes Credit Union Ltd
Southern Cross Credit Union Ltd
South-West Credit Union Co-Operative Limited
Summerland Credit Union Limited
Suncorp-Metway Limited
Sutherland Credit Union Ltd
Swan Hill Credit Union Limited
Sydney Credit Union Ltd
Teachers Mutual Bank Limited
The Broken Hill Community Credit Union Ltd
The Capricornian Ltd
The Gympie Credit Union Ltd
The Rock Building Society Limited
The University Credit Society Limited
Traditional Credit Union Limited
TransComm Credit Co-operative Limited
Transport Mutual Credit Union Limited
Victoria Teachers Limited (trading as Victoria Teachers Mutual Bank)
Warwick Credit Union Ltd
WAW Credit Union Co-Operative Limited
Westpac Banking Corporation
Wide Bay Australia Ltd
Woolworths Employees' Credit Union Limited
Wyong Shire Credit Union Ltd
BSB
*
Account Number
*
Please enter a number from
1000
to
999999999
.
Account Name
*
Automated Payment Method
I/We hereby authorise TrueCom Pty Ltd ACN 132 135 543 (herein referred to as “TrueCom”) to make periodic debits as indicated in the Direct Debit Request (Schedules 1, 2 & 3). 2. I/We acknowledge that the debit amount will be debited from my/our account according to the terms and conditions of my/our agreement with TrueCom and the terms and conditions of the Direct Debit Request (and specifically the Debit Arrangement and the Fees/Charges detailed in the Direct Debit Request) and this DDR Service Agreement. 3. I/We acknowledge that bank account and/or credit card details have been verified against a recent bank statement to ensure accuracy of the details provided and I/We will contact my/our financial institution if I/We are uncertain of the accuracy of these details. 4. I/We acknowledge that is my/our responsibility to ensure that there are sufficient cleared funds in the nominated account by the due date to enable the direct debit to be honoured on the debit date. Direct debits normally occur overnight, however transactions can take up to three (3) business days depending on the financial institution. 5. Accordingly, I/We acknowledge and agree that sufficient funds will remain in the nominated account until the direct debit amount has been debited from the account and that if there are insufficient funds available, I/We agree that TrueCom will not be held responsible for any fees and charges that may be charged by either my/our or its financial institution. 6. I/We acknowledge that there may be a delay in processing the debit if:- (a) there is a public or bank holiday on the day of the debit, or any day after the debit date; (b) a payment request is received by TrueCom on a day that is not a banking business day in Victoria; (c) a payment request is received after normal TrueCom cut off times, being 4:00pm Victoria time, Monday to Friday. Any payments that fall due on any of the above will be processed on the next business day. 7. I/We authorise TrueCom to vary the amount of the payments from time to time as may be agreed by me/us and TrueCom. 8. I/We acknowledge that TrueCom is to provide at least 14 days' notice if it proposes to vary any of the terms and conditions of the Direct Debit Request or this DDR Service Agreement including varying any of the terms of the debit arrangements between us. 9. I/We acknowledge that I/We will contact TrueCom if I/We wish to alter or defer any of the debit arrangements. 10. I/We acknowledge that any request by me/us to stop or cancel the debit arrangements will be directed to TrueCom. 11. I/We acknowledge that any disputed debit payments will be directed to TrueCom. If no resolution is forthcoming, I/We agree to contact my/our financial institution. 12. I/We acknowledge that if a debit is returned by my/our financial institution as unpaid, a failed payment fee is payable by me/us to TrueCom. I/We will also be responsible for any fees and charges applied by my 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 TrueCom. 13. I/We authorise TrueCom to attempt to re-process any unsuccessful payments. 14. I/We acknowledge that certain fees and charges (including setup, variation, SMS or processing fees) may apply to the Direct Debit Request and may be payable to TrueCom. 15. You appoint TrueCom as your exclusive agent with regard to the control, management and protection of your personal information (relating to TrueCom and contained in this DDR Service Agreement). You irrevocably authorise TrueCom to take all necessary action (which we deem necessary) to protect your personal information, including (but not limited to) prohibiting the release to or access by third parties without our consent. 16. You hereby irrevocably authorise, direct and instruct any third party who holds/stores/keeps your personal information (relating to TrueCom and contained in this DDR Service Agreement) to release and provide such information to TrueCom on our written request. 17. Credit Card Payments. I/We acknowledge that “TrueCom” will appear as the merchant for all payments from my/our credit card. 18. I/We acknowledge and agree that in the event that a claim is made, TrueCom will not be liable for the refund of any funds and agree to reimburse TrueCom for any successful claims made by the Card Holder through their financial institution against TrueCom. 19. TrueCom will keep your information about your nominated account at the financial institution private and confidential unless this information is required to investigate a claim made relating to an alleged incorrect or wrongful debit, or as otherwise required by law. 20. I/We authorise: a) TrueCom to verify details of my/our account with my/our financial institution; and b) my/our financial institution to release information allowing TrueCom to verify my/our account details
I/we authorise and request BINARY NETWORKS PTY LTD to debit payments from my/our account, as specified above, at intervals and amounts as per the TRUECOM PTY LTD Standard Form of Agreement until notified otherwise by me/us.
*
I agree
I hereby have read, understand and agree to be bound to all terms and conditions of the standard Form of Agreement (SFOA) available upon request or via our website http://www.binarynetworks.com.au/legal/sfoa I am authorised to enter into this agreement on behalf of the organisation as described above.
*
I agree