SDA Electronic Authority to direct debit for McDonalds members

Electronic Authority to direct debit for McDonalds members

Name*
First Last
Phone
Email
Hours per week worked?*
How often would you like to pay your fees?*
Up to 10 hours Subscription - weekly
Price:
Up to 10 hours Subscription - fortnightly
Price:
10-20 hours Subscription - weekly
Price:
10-20 hours Subscription - fortnightly
Price:
20+ hours Subscription - weekly
Price:
20+ hours Subscription - fortnightly
Price:
Payment Instruction
Regular Debit
Regular fortnightly amounts of:
$ 0.00
Regular weekly amounts of:
$ 0.00
Payment Method
Pay By*
- Bank Account
- Credit Card
Institution Name

eg: Commonwealth Bank
Branch

eg: Suburb where branch is located
BSB*
Account Number*
Account Holder Name(s)*
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
I/we authorise Bpoint APCA User ID Number 064396 to debit my/our accounts at the Financial institution identified above through the Bulk Electronic Clearing System (BECS)
Other Comments
Authorisation
*
- This authorisation is to remain in force in accordance with the Terms and Conditions which I/we have read and understood
Declaration and Signature
*
- I understand that on receipt of this ‘electronic’ information, the SDA may contact me by phone, email or letter requesting further details that will determine my eligibility for membership. I understand that the SDA will forward my application on to my employer to proceed with payroll deduction of fees. I further understand that the SDA can only represent my interests from the date that membership is accepted. I also note that under no circumstances will the SDA become involved in issues or disputes occurring before that date.
Signature

Electronic Authority to direct debit for McDonalds members

Payment Instruction

Payment Method

Authorisation

Declaration and Signature

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Electronic Authority to direct debit for McDonalds members

Payment Instruction

Payment Method

Authorisation

Declaration and Signature

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