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You are about to create a Direct Debit Request for Ultimate Car Wash
Please enter your details, including the reference number given to you
You may enter one or both of the once off and regular debit arrangements
One Time Setup Fee
Optional SMS Reminder
2.5% (min $1.10)
4.4% (min $1.10)
Please choose a method of payment
Please enter your bank account details
Please enter your credit card details
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.
Payments will appear on your statement as EZI*ULTIMATECARWAS
By agreeing to this form, I / We authorise Ezidebit, acting on behalf of the Business, to debit payments from my specified Credit Card above, and I / we acknowledge that EZI*ULTIMATECARWAS will appear as the merchant on my credit card statement. Furthermore, I / we agree to reimburse and indemnify Ezidebit for any successful claims made by the Card Holder through their financial institution against Ezidebit.
*This is a preview page only, no payments can be taken on this page.