Direct Debit Request

Your Surname or Company Name*
Your Given Names or ABN/ACN*

I request and authorise OilCorp Fuels Pty Ltd to arrange, through its own financial institution, a debit to your nominated account any amount, OilCorp Fuels Pty Ltd has deemed payable by you.

This debit or charge will be made through the Bulk Electronic Clearing System (BECS) from your account held at the financial institution you have nominated below and will be subject to the terms and conditions of the Direct Debit Request Service Agreement.

Financial Institution Name*
Financial Institution Address*
Name/s On Account*
BSB Number* (Must be 6 Digits)
Account Number*
I agree to the Terms and Conditions. Click here to read the terms and conditions.
I agree to use electronic records, signatures and be bound through the use of electronic forms