Bank* Bank is required.

Account owner* Account owner is required.

Account Number*

Bank

Branch

Account

Suffix

Bank component must be a 2 digit integer.

Branch component must be a 4 digit integer.

Account component must be a 7 digit integer.

Suffix component must be a 2-3 digit integer.

Are you ({{ContactInformation.ContactName}}) authorised to operate the bank account nominated above individually, and not jointly, i.e. requiring two signatures.

Do you ({{ContactInformation.ContactName}}) authorise Vocus Communications to take payment of any amounts owing on your account by Direct Debit each month on the due date?

Do you ({{ContactInformation.ContactName}}) acknowledge that the bank accepts this authority to set the Direct Debit on your behalf?

Please check and agree for all the conditions in order to proceed to the next step.

A confirmation email will be sent to you within 5 business days.