Debit

Name of your bank

Name of account to be debited:

AUTHORITY TO ACCEPT
DIRECT DEBITS

(Not to operate as an assignment or an agreement)

Account details:

AUTHORISATION CODE

0333277

Your email and address details:

Date

I/We authorise you until further notice in writing to debit my/our account with you with all amounts which

"All Good Bananas Ltd" (hereinafter referred to as tho Initiator)

The registered Initiator of the above Authorisation Code may Initiate by Direct Debit.
I/We acknowledge and accept that the Bank accept this Authority only upon the conditions listed on this form.

Information to appear In my/our bank statement:

I authorize my bank to direct debit this account with amounts of direct debit from "All Good Bananas Ltd" in accordance with this authority and confirm:

I have sole signing authority on this bank account and do not need to jointly authorise debits. 2 sign authorisation form here

I am acting on behalf of the customer

The person has authority to operate the bank account alone, i.e. more than 1 account holder is not required to jointly authorise debits from the account.

I agree this authority is subject to terms and conditions relating to my bank account and have read and agree to the specific direct debit terms and conditions that relate to this authority

We will send you details of this authority within the next 5 business days. If you wish to cancel this direct debit authority please contact us on 09 320 4691.

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