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Direct Debit Arrangement

Please fill out this form to set up a direct debit arrangement for your debt. We will action your request as soon as possible and email you when it's done.

Note:

Please review the terms and conditions of this Authority which can be found here, and our Privacy Policy, which can be found here.

Fields with an asterisk are required.

Please only use Australian bank account details.

1. Enter your details

CCID / Reference number*

First name / Company name*

Middle name(s)

Last name or ABN/ARBN*

Email*

Phone number*

Postal Address*

Suburb*

City / region*

Country*

Post code*

Date of Birth*

Centrelink Customer Reference Number (CRN)

Employer name (if applicable)

Employer address (if applicable)

2. Payment Details

I agree to the payment arrangement set out below with DebtManagers in respect of the debt(s) I owe to DebtManagers. This payment arrangement is instead of paying the full amount of the debt immediately.

I agree to execute a direct debit authority in favour of DebtManagers to allow them to debit my account directly. The details of the payment arrangement/authority are detailed below.

I can cancel this arrangement and the direct debit authority at any time for any reason by contacting my bank or DebtManagers.

I accept that there could be consequences of cancelling, including that I may need to immediately repay the debt or DebtManagers may without further notice bring legal proceedings against me for this / these debt(s).

Name on account*

BSB Number (must be 6 digits, dash added automatically)*

Bank account number (6-10 digits)*

Amount to pay*

Frequency*

Start date*

3. Authorisation

By signing and/or providing us with a valid instruction in respect to your Direct Debit Request, you confirm you have understood and agreed to the terms and conditions governing the debit arrangements between you and DebtManagers Ledger Pty Ltd, User No: 643311. You also authorise us to debit your nominated bank account as set out in this request in accordance with the Direct Debit Request Service Agreement (available at the top of the page and here). The debit or charge will be made through the Bulk Electronic Clearing System (BECS) from your account held at the financial institution you have nominated above.

I/We acknowledge that the debt owed by me/us to DebtManagers Ledger Pty Ltd remains outstanding at the date this document is executed.

Signature of Accountholder
(Type your name as your e-signature. Companies: use the full name and capacity for signing eg. Director)

DebtManagers Ledger Pty Ltd will not charge any fees for this payment arrangement.*

5. Email / Postal Address for Service

I agree that any communications, notices, statements of accounts, disclosures (including any required under the National Credit Code) and service (including the service of any document relating to legal proceedings) in connection with:

(a) This payment arrangement;

(b) Any other payment arrangement, loan, or other debt owed to the DebtManagers (whether by assignment or otherwise), whether entered into before or after this payment arrangement; and

(c) Any other payment arrangement, loan, or other debt that the DebtManagers may be collecting on behalf of a third party whether entered into before or after this payment arrangement;

(d) May be validly sent or served to me in person, electronically or by post to either the mobile number, the email address or postal address (which may include a post office box address) I have provided above;

(e) I understand that this agreement in relation to communications etc extends beyond this payment arrangement and shall survive termination or expiration of this payment arrangement (including through repayment). I agree that this agreement can be assigned to third parties to whom I owe money (even if such debt arises after the date of this agreement). I also agree that this agreement is governed by the laws of New South Wales, Australia and irrevocably and unconditionally submit to the non-exclusive jurisdiction of the courts of New South Wales, Australia and Commonwealth courts with jurisdiction in that state;

(f) I agree to advise DebtManagers of any changes to my mobile number, email address or postal address and that if I fail to do so I will still be treated as having received copies of all relevant documents provided to a number or an address listed above in this form.

1. Enter your details 2. Payment Details 3. Authorisation 4. Declarations 5. Email / Postal Address for Service

Enquiry forms

Make a payment Active Request a statement Questions about payment I’ve been contacted by DebtManagers Make a complaint Hardship Financial Counsellor enquiries

Australia contact information

Contact

1800 218 774 hello@debtmanagers.com.au

Address

PO Box 4846
Eight Mile Plains
QLD, 4113

Hours

Monday – Friday
7am – 8pm

Media Enquiries

Sam Durbin
Senior Marketing & Communications Manager
sam.durbin@debtmanagers.co.nz