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Personal Details

Business Details

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).

By completing and submitting this application form the Business acknowledges that it has read and considered the combined Financial Services Guide and Product Disclosure Statement and agrees to be bound by Ezidebit's Terms and Conditions, eWAY's Gateway Terms and Conditions, as well as any terms within this application form.

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.