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You are about to create a Direct Debit Request for Ultimate Car Wash

Customer Details

Please enter your details, including the reference number given to you












Debit Arrangement

You may enter one or both of the once off and regular debit arrangements

Once Off Debit


Regular Debits




One Time Setup Fee

$5.50

Bank Account

$1.20

Optional SMS Reminder

$0.00

Visa/Mastercard

2.5% (min $1.10)

Amex/Diners

4.4% (min $1.10)

Failed Payment Fee

$0.00

Payment Method

Please choose a method of payment





Payments will appear on your statement as ULTIMATECARWASH

I / We authorise Global Payments Australia 1 Pty Ltd ACN 601 396 543 (User ID No 342190, 342191, 428198) to debit my/our account at the Financial Institution identified above through the Bulk Electronic Clearing System (BECS) in accordance with this Direct Debit Request.

Service Agreement

*This is a preview page only, no payments can be taken on this page.