Direct Debit Service Agreement

Direct Debit Service Agreement Terms and Conditions

I am requesting:*This field is required.

Contact Details

New Direct Debit Arrangement: Deduction Frequency

Please select your preferred deduction frequency if you are setting up a new Direct Debit Agreement. Note: A one-time administration fee of $45.00 applies for periodic deductions.

Weekly and fortnightly payments are deducted on a Friday; Monthly payments are deducted on the 17th of each month.


Periodic Deduction: Is this agreement to discontinue after 30 June 2025?

Change to Existing Agreement

Change Amount or Frequency of Current Periodic Deduction
Deduction Frequency


Cancellation or Suspension of Existing Agreement

Bank Details

Please complete this section if you need to update the bank details on your existing agreement.

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.