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CritterCare Enrolment Form

"We Care About You And Your Pet"
  • DIRECT DEBIT REQUEST

    Request and Authority to debit the account named below to pay Hervey Bay Veterinary Surgery, User ID 478268
  • Request and Authority to debit

  • The above named request and authorise Hervey Bay Veterinary Surgery to arrange, through its own financial institution, a debit to your nominated account any amount Hervey Bay Veterinary Surgery, has deemed payable by you.

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

  • Insert the name and address of the financial institution at which the account is held

  • Insert details of account to be debited

  • By signing 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 the debit arrangements between you and Hervey Bay Veterinary Surgery as set out in this Request and in your Direct Debit Request Service Agreement.
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