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Direct Debit


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To download the Direct Debit Form as a PDF printable page, click here. You will need the PDF plugin for you browser.

Read the Customer Service Agreement

Please fill out the form below to apply for Direct Debit:

Name:
Company:
Address:
City:
State:
Postcode:
Phone:
Email Address:

Authorise Earth Share Australia (APCA ID = 109023) to DEDUCT MONTHLY until further notice in writing the amounts (given below):

$100
$50
$40
$30
$20
$10
other amount
to be debited from my/our account, at the Financial Identified and as described in the Schedule below.
THE SCHEDULE
Details of your account which you wish to have debited
The Account is held in the name of:
Financial Institution BSB:
(eg. bank/credit union)

            (six figure number)
Your Account Number:
Name of your Financial Institution:
Address of your Financial Institution:


IMPORTANT: You must include all details about your financial institution. Please note direct debiting is not available on the full range of accounts. If in doubt phone your financial institution.

I have read the customer service agreement from Earth Share Australia and agree with its terms and conditions. I/we request that this arrangement remain in force in accordance with the details set out in the schedule described above and in compliance with the customer service agreement:

Your Name:
Your Name: (if shared account)
Date:
I WISH MY DONATION TO BE DISTRIBUTED AS FOLLOWS:

Please distribute my donation equally to all Earth Share member organisations
OR
Please distribute my donation to the member organisation nominated below (if you nominate more than one organisation your donation will be split equally between those organisations):
Arid Lands Environment Centre
Australian Conservation Foundation
Conservation Council of South Australia
Conservation Council of Western Australia
Environment Victoria 		Friends of the Earth Australia
Nature Conservation Council of NSW
Queensland Conservation Council
Tasmanian Conservation Trust
The Wilderness Society

 

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