REDMAKO LEARNING PTY LTD DIRECT DEBIT REQUEST

You may contact us through: Phone: (07)33391417 Email: ar@redmako.com.au Mail: 12/23 Breene Place Morningside, QLD, Australia

Part A - Student's Details
Student's Name*
First Last
Student's Email Address*
Phone*
Course Selection
Diploma Course Selection*
- SITHFAB002 RSA + S.M.A.R.T
Part B - Payer's Details
Parent's Name
Parent's Name*
First Last
Parent's Phone Number*
Parent's Email Address*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Part C - Amount
RSA Tuition Fee is non-refundable
Description Authorized Amount When Payable

Tuition Fee $ 100.00 upon enrolment
Part D - DIRECT DEBIT REQUEST
Choose one of the following two (2) payment options by ticking the box
1) Direct Debit from Bank Account
Direct Debit*
I/We request and authorize REDMAKO LEARNING PTY LTD to arrange, through its own financial institution, a debit to your nominated account any amount REDMAKO LEARNING PTY LTD, has deemed payable by you. This debt or charge will be made through the Bulk Electronic System (BECS) from your account held at the financial institution you have nominated below and will be subject to terms and conditions of the Direct Debit Request Service Agreement. By signing and/or providing us with a valid instruction in request to your Direct Debit Request, you have understood and agreed to the terms and conditions governing the debit arrangement between you and REDMAKO LEARNING PTY LTD as set out in this Request and in your Direct Debit Request Service Agreement
- I Agree*
Financial Institution*
Branch*
Account Name*
BSB Number*
Account Number*
Signature*
Date Signed*
Date Signed
Date Format: MM slash DD slash YYYY
OR
2) Direct Debit from Credit Card
Credit Card*
- I request REDMAKO LEARNING PTY LTD to arrange for funds to be debited from my nominated credit card according to the schedule specified above and attached Direct Debit Service Agreement
Credit card to use*
Credit card to use*
- Amex
- Visa
- Mastercard
Credit Card Number*
Expiry Date*
Cardholder Name*
Signature
Signature*
Date Signed*
Date Signed
Date Format: MM slash DD slash YYYY

REDMAKO LEARNING PTY LTD DIRECT DEBIT REQUEST

Part A - Student's Details

Part B - Payer's Details

Part C - Amount

Part D - DIRECT DEBIT REQUEST

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