I/We request and authorise The Centre for Creative Health (520890) to arrange, through its own financial institution, a debit to your nominated account any amount The Centre for Creative Health (520890), 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.

I/We request and authorise Acknowledgement. By signing and/or providing us with a valid instruction in respect to your Direct Debit Request, you have understood and agreed to the terms and conditions governing the debit arrangements between you and The Centre for Creative Health (520890) as set out in this Request and in your Direct Debit Service Agreement.