BPAY Request T 1300 655 116 F 02 9965 1222 P Locked Bag 7003 Concord West NSW 2138 E
[email protected]
ABN 59 087 650 584 AFSL 246941
Personal details Member number
Contact number
Member name(s) I/we authorise the Credit Union to make the following BPAY payment: Member number
From
Account type (s1, s2, etc.)
to Biller name Biller code Customer reference number $
Amount
You must ensure that the Biller code and Reference are correct or your payment may be unsuccessful or may be paid to an unintended account. If you pay monies to an unintended account, you may be liable for the loss if the funds are unable to be retrieved from the biller. Note the receiving biller may not validate the account name and may rely solely on the reference number. BPAY transactions requested before 3:00pm (AEST) on a Banking Business Day will be sent to the biller on the same day. BPAY transactions requested after this time may be sent on the next Business Banking Day. When the biller will receive the payment depends on the policy and systems of the biller’s bank, however they are generally received within 1 - 2 business days.
Member signature(s) Member 1 signature
Date
/
/
Member 2 signature
Date
/
/
Note: This authority must be signed in accordance with the membership signing authority
Branch use only Member 1 sig verified
Transaction processed
Member 2 sig verified
Receipt number
Completed by Op No. Date
/
/ F006_1 09/14