Bill Butler Pty Ltd (314011) Direct Debit Request (DDR) Part AClient NameClient PhoneClient AddressPart BPayments will be debited on the due date. Date Format: MM slash DD slash YYYY Part CPayments will be debited on the due date. Date Format: MM slash DD slash YYYY Part DI/We request and authorise BILL BUTLER PTY LTD (314011) to arrange, through its own financial institution, a debit to your nominated account any amount BILL BUTLER PTY LTD (314011), 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.Financial InstituteBranch NameAccount NameAccount NumberBSB NumberI/We request and authorise Acknowledgement. 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 BILL BUTLER PTY LTD as set out in this Request and in your Direct Debit Request Service Agreement.If debiting from a joint bank account, both signatures are required.