Sign your Direct Debit Authority

Sign below to authorise Eftpos Systems Limited to direct debit your account for everything you buy from us — EFTPOS terminals, merchant service fees, consumables, accessories, repairs, hire, and any other invoices or statements we send you. This replaces a separate paper form; your signature below is applied to the official direct debit authority automatically.

Want to read the form first? View the blank, unsigned authority (PDF).

Your name *

Please enter your name.

Your email *

Please enter a valid email address — we'll send you a copy of the signed authority.

Business / trading name *

Please enter the business or trading name.

Bank *

Select your bank.

Account name *

Enter the account name.

Settlement account number *

Enter a valid account number.

Signature

This bank account requires two authorised signatories to approve a direct debit.

Your signature *

Sign here with your mouse, trackpad or finger

Captured as an image, along with the date, time and your IP address.

Please sign above before continuing.

I authorise Eftpos Systems Limited (Initiator) to direct debit the bank account given above for any amount I owe Eftpos Systems Limited under our terms of trade — including terminal fees, merchant service fees, consumables, accessories, repairs, hire charges, and any other invoice or statement properly issued to my account — under the terms of that direct debit authority. I confirm the signature(s) above are mine and/or the named second signatory's (who will separately confirm their own signature via the link we send them, where applicable), and that submitting this form electronically is my signature on the direct debit authority.

I authorise the direct debit as described above. *

Please confirm you authorise the direct debit.

Signed and submitted

Thanks — your Direct Debit Authority has been signed and sent to Eftpos Systems Limited. A copy has also been emailed to you for your own records.