Direct Debit Credit Card Authority
Please complete the details below and return to: Primus Telecom, GPO Box 14150, Melbourne City MC, Melbourne VIC 8001 Your Customer Number (refer to the top right hand corner of your bill): ______________________________________ Account Holder Name (as on your Primus bill): __________________________________________________________________________________ Credit Card Type Bankcard MasterCard Visa AMEX Diners
Credit Card Number
EXPIRY DATE: ______/ ______ I_________________________________ hereby authorise Primus Telecom to collect payment of my future Primus Telecom bills for the above customer number, when due, by direct debit from the above credit card. Name appearing on Credit Card:________________________________________________ Card holder's signature:_____________________________ Date:_____________________ Primus Telecom will only use your information for the express purpose contained in this form. For more information please refer to our Privacy Statement at http://www.primustel.com.au
An account is identified by its customer number. Please note that if you have more than one customer number with Primus, you will need to sign an authority for each customer number. The bill for each account shows all charges for goods and services supplied by Primus Telecom for the billing periods as shown on your bill.
Primus Telecommunications Pty Ltd ABN 69 071 191 396 Primus Telecommunications (Australia) Pty Ltd ABN 77 064 754 943