BANKER'S ORDER
THE MANAGER
BANK: BRANCH: ADDRESS:
RE: REQUEST FOR DEBITING AMOUNT/S TO ACCOUNT/S BY THE DIRECT DEBIT SYSTEM I/WE OF REQUEST YOU TO DEBIT MY/OUR ACCOUNT DESCRIBED IN THE SCHEDULE BELOW THE SUM OF DOLLARS (AUD$____________) TOGETHER WITH BANK CHARGES, ON THE DAY OF EACH MONTH COMMENCING ON THE ____/____/____ AND CONTINUING FOR A TOTAL OF _____ MONTHS, THE LAST PAYMENT TO BE MADE ON THE ____/____/____. I/WE HEREBY FURTHER AUTHORISE YOU TO PAY THE ABOVEMENTIONED FUNDS DIRECTLY INTO THE BANK ACCOUNT OF THE ENTITY SO AFTER MENTIONED. DATE / /
NAME OF ACCOUNT: BANK ADDRESS: ACCOUNT NO: SIGNATURE/S: WITNESS:
DATE / /
CHEQUES SHOULD BE CROSSED IN FAVOUR OF AND MADE PAYABLE DIRECTLY INTO THE ACCOUNT OF:
NAME OF ACCOUNT: BANK: ACCOUNT NUMBER: BSB: SWIFT CODE: