Direct Debit Request Form

Request to establish debit authority in the Direct Debit system

Employers are stopping payroll deductions. The quickest and easiest way to make sure you stay protected at work is to pay your union fee's by direct debit. By doing this you may also qualify for new benefits including the new ETU Funeral Benefit of up to $7,000*.

*conditions apply.

* Required

Personal Details

First Name *

Last Name *

Given Name

Company

Email Address *

Union Membership Number *

Address

Address *

City *

State *

Postcode *

Authorise the CEPU Electrical Division, NSW Branch, (ACPA ID 025902), to arrange for funds to be debited from my/our account at the financial institution identified below and as prescribed below through the Bulk Electronic Clearing Systems (BECS).

This authorisation is to remain in force in accordance with the terms described in the Customer Service Agreement.

Details of account to be debited:

(Insert the name and address of the Financial Institution at which your account is held).

(Please note direct debiting through BECS is not available on the full range of accounts. If in doubt, please refer to your Financial Institution).

Direct Debit Type *

Payment Credit Card or Bank Account *

I/We have read the Customer Service Agreement and acknowledge and agree with its terms and conditions.

I/We request this arrangement to remain in force in accordance with details set out in the schedule described above and in compliance with the "Customer Service Agreement".

I Accept

Date *

Please confirm you're not a robot: *