By submitting this application, the Business authorises Ezidebit to conduct transactions in relation to this account pursuant to the terms and conditions of any contractual agreement between Ezidebit and the BUSINESS named above. The administration of this authority is conducted by Ezidebit (Debit User 165969, 428198) through the Bulk Electronic Clearing System (BECS).
I represent and warrant that I am authorised by the Business to complete and sign this application on behalf of the Business and that the information is true and correct.
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