Direct Debit Service Agreement - New Instalment Plan

Direct Debit Service Agreement Terms and Conditions

Contact Details

New Direct Debit Arrangement: Instalment Options

Instalment Payments*This field is required.


Instalment Payments: Is this agreement to discontinue after 30 June 2026?*This field is required.

Bank Details

Acknowledgement and Declaration

Direct Debit Arrangement Acknowledgement

I acknowledge that the Direct Debit Arrangement is governed by the Terms and Conditions of the “Direct Debit Service Agreement” (DDSA). I accept all charges associated with the arrangement as determined by the City. I authorise the City of Kalgoorlie-Boulder DE USER ID 317863 to arrange for funds to be debited from my/our bank account at the Bank/Financial Institution shown above through the Bulk Electronic Clearing System (BECS).

Account Holder's Agreement*This field is required.
Declaration

I declare that I am the owner and ratepayer of the above mentioned property and I have read, understood
and agree to be bound by the Terms and Conditions of the Direct Debit Service Agreement.

Owner/Ratepayer Direct Debit Service Agreement*This field is required.