Pay By Direct Debit

How to Pay by Direct Debit

Fill out the direct debit Authorisation form

VitalCALL’s commitment to the Account or Card Holder, Drawing arrangements: Where the due date falls on a non-business day, we will draw the amount on the next business day. VitalCALL will not change the amount or frequency of drawing arrangements without your prior approval or notification. VitalCALL reserves the right to cancel the Automatic Withdrawal arrangements and or VitalCALL service if three or more drawings are returned unpaid by your nominated Financial Institution and to arrange with you alternate payment methods. Where a drawing fails due to insufficient funds VitalCALL reserves the right to second attempt drawing within 30 days. VitalCALL will keep all information pertaining to your nominated account at the Financial Institution, private and confidential. Please refer to the Privacy Statement and the VitalCALL (Chubb) Privacy Policy. VitalCALL’s Privacy Policy is available on request or at www.chubb.com.au VitalCALL reserves the right to charge any related administration fees with regards to the failure of the direct debt when the circumstances are based on the non-communication of the following: drawing arrangements are cancelled either by the account holder or the nominated financial institution; insufficient funds are available in the nominated bank account to meet a drawing on the due date.

Account Holders commitment to VitalCALL, Your responsibilities: It is the account holder’s responsibility to ensure that sufficient funds are available in the nominated account to meet a drawing on its due date. It is the account holder’s responsibility to ensure that authorisation given to draw on the nominated account is identical to the account signing instruction held by the financial institution where the account is based. It is your responsibility to advise us if the account nominated by you to receive the VitalCALL drawings is transferred or closed. It is the account holders responsibility to arrange with VitalCALL a suitable alternate payment method if the VitalCALL – Automatic Withdrawal arrangements are cancelled by either yourself the nominated financial institution and or VitalCALL.

Customer Rights: The customer may terminate the VitalCALL drawing arrangements at any time by giving written notice to us. Such notice should be received by us at least 28 business days in advance. The customer may request changes to the drawing amount and/or frequency of VitalCALL drawings by contacting us and advising your requirements no less than 28 business days prior to the due date. Where the customer considers the drawing has been initiated incorrectly (outside the VitalCALL – Automatic Withdrawal agreement) you should take the matter up directly with VitalCALL on 1300 848 252.

I acknowledge that this automatic withdrawal arrangement is governed by the terms of the client service agreement detailed above

Direct Debit Authorisation Form

Set up a regular payment

"*" indicates required fields

Customer Details

Name*

First Last

Account Number*

Phone*

Mobile

Customer Email

Payer Details

Organisation (If Applicable)

Payer Name*

First Last

Payer Address*

Street Address City State Post Code

Payer Phone Number*

Payer Mobile

Payer Email

Relationship to customer*

There are 2 options available for direct debit withdrawals, please select one of them below:

Payment Method*

Option 1: Pay by saving or cheque account

Account Name*

BSB Number*

Account Number*

Bank*

Branch*

Option 2: Pay by credit card

*Please Note: We accept Visa or Mastercard only

Name on Card*

Card Number*

Expiry Date*

Format: MMYY (2 Digit year only)

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