Direct Debit Authority

DIRECT DEBIT AUTHORITY

I/we request that Raine & Horne Umina Rental Trust A/C arrange for funds to be debited from my/our nominated account for rent and associated water usage charges at the financial institution shown below according to the schedule specified below, via the bulk electronic clearing system.

Name:                                                                                            

Address:                                                                                         

                                                                             P/Code:             

Bank:                                                         Branch:                       

BSB:                               qqq-qqq

Account Number:     qqqqqqqqq

Commencing On:      qq - qq - qq (Please Debit)

Please Debit  $                     from the above account each

Week    q    on:                                  

Fortnight   q  Month   q    Other:                                   

Signature/s:

If debiting from a joint bank account both signatures are required

Date:      qq - qq - qq