Kindergarten Direct Debit Request

Complete the form below to request your kindergarten fees to be direct debited from your bank account.

Please review the Direct Debit Service Agreement before completing the form.

This debit or charge will be made through the Bulk Electronic Clearing System (BECS) from your account held at the financial institution you nominate below and will be subject to the terms and conditions of the Direct Debit Request Service Agreement.

To Latrobe City, I/we request and authorise Latrobe City Council user APCA ID 141527 to draw by way of the Direct Debit System from my/our account as follows:

Bank Account Details

Name of Financial Institution

Insert name/s in which account is held and is to be debited

BSB Number

Account Number (Credit/Debit Card not available)

Is this a joint bank account?

Yes

If you have nominated a joint account, both customer details must be supplied.

Child's Details

Child's Full Name

Kindergarten Child will be attending

Kindergarten program

4 year old kindergarten

3 year old kindergarten

Payment Options

Please select a payment option below

Year in advance $1,160.00 + $31 admin fee - Amount will be deducted the following Friday after receiving your statement/ invoice.

Quarterly 4x instalments $290.00 + $31 admin fee - Amount will be deducted the following Friday after receiving your statement/ invoice.

Fortnightly - 20 x instalments $58.00+ $31 admin fee.

Please select a payment option below

Year in advance $400.00 + $31 admin fee - Amount will be deducted the following Friday after receiving your statement/ invoice.

Quarterly 4x instalments $100.00 + $31 admin fee - Amount will be deducted the following Friday after receiving your statement/ invoice.

Fortnightly - 20 x instalments $20.00+ $31 admin fee.

Please choose a start date for your fortnightly payment

Friday 18 February 2022

Friday 25 February 2022

Your first direct debit will be deducted on 25/02/2022.

This form must be submitted at least 10 working days prior to commencement date.

Customer 1

Customer 1 Surname or Company/Business Name

Customer 1 Given Names or ACN/ARBN/ABN

Customer 1 Postal Address

Customer 1 Contact Number

Customer 1 Email Address

Customer 1: By selecting the box and/or providing us with a valid instruction in respect to your Direct Debit Request, you have understood and agreed to the terms and conditions governing debit arrangements between you and Latrobe City Council as set out in this Request and in your Direct Debit Request Service Agreement.

Acknowledgement

I acknowledge Victorian State Laws and will accept this communication as containing my signature within the meaning of Victoria Electronic Transaction Act 2000

Customer 2

Customer 2 Surname or Company/Business Name

Customer 2 Given Names or ACN/ARBN/ABN

Customer 2 Postal Address

Customer 2 Contact Number

Customer 2 Email Address

Customer 2: By selecting the box and/or providing us with a valid instruction in respect to your Direct Debit Request, you have understood and agreed to the terms and conditions governing debit arrangements between you and Latrobe City Council as set out in this Request and in your Direct Debit Request Service Agreement.

Acknowledgement

I acknowledge Victorian State Laws and will accept this communication as containing my signature within the meaning of Victoria Electronic Transaction Act 2000

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Kindergarten Direct Debit Request

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Latrobe Regional Gallery

Latrobe City Council
Ph: 1300 367 700
Fax: (03) 5128 5672
Email: latrobe@latrobe.vic.gov.au
Post: PO Box 264, Morwell VIC 3840
Location: 141 Commercial Road, Morwell VIC 3840 (Australia)