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VitalCall is Australia’s
leading provider of 24 hours a day, 7 day a week personal emergency response alarms.

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How To Pay By Direct Debit

DIRECT DEBIT AUTHORISATION FORM

VitalCall’s commitment to the Account or Card Holder, Drawing arrangements: Where the due date falls on a non-business day, we will draw the amount on the next business day. VitalCall will not change the amount or frequency of drawing arrangements without your prior approval or notification. VitalCall reserves the right to cancel the Automatic Withdrawal arrangements and or VitalCall service if three or more drawings are returned unpaid by your nominated Financial Institution and to arrange with you alternate payment methods.
VitalCall will keep all information pertaining to your nominated account at the Financial Institution, private and confidential. Please refer to the Privacy Statement and the VitalCall (Chubb) Privacy Policy. VitalCall’s Privacy Policy is available on request or at www.chubb.com.au VitalCall reserves the right to charge any related administration fees with regards to the failure of the direct debt when the circumstances are based on the non-communication of the following: drawing arrangements are cancelled either by the account holder or the nominated financial institution; insufficient funds are available in the nominated bank account to meet a drawing on the due date.
Account Holders commitment to VitalCall, Your responsibilities: It is the account holder’s responsibility to ensure that sufficient funds are available in the nominated account to meet a drawing on its due date. It is the account holder’s responsibility to ensure that authorisation given to draw on the nominated account is identical to the account signing instruction held by the financial institution where the account is based. It is your responsibility to advise us if the account nominated by you to receive the VitalCall drawings is transferred or closed. It is the account holders responsibility to arrange with VitalCall a suitable alternate payment method if the VitalCall – Automatic Withdrawal arrangements are cancelled by either yourself the nominated financial institution and or VitalCall.
Customer Rights: The customer may terminate the VitalCall drawing arrangements at any time by giving written notice to us. Such notice should be received by us at least 28 business days in advance. The customer may request changes to the drawing amount and/or frequency of VitalCall drawings by contacting us and advising your requirements no less than 28 business days prior to the due date. Where the customer considers the drawing has been initiated incorrectly (outside the VitalCall – Automatic Withdrawal agreement) you should take the matter up directly with VitalCall on 1300 360 808
I acknowledge that this automatic withdrawal arrangement is governed by the terms of the client service agreement detailed above

CUSTOMER DETAILS

CUSTOMER NAME ACCOUNT NUMBER
PHONE MOBILE

PAYER DETAILS

ORGANISATION NAME(if applicable) RELATIONSHIP TO CUSTOMER
CONTACT NAME/S CUSTOMER
FAMILY MEMBER
FRIEND
FUNDING ORGANISATION
CARER/DOCTOR
POA
OTHER
STREET ADDRESS
SUBURB
STATE
POST CODE
PHONE
MOBILE

THERE ARE 2 OPTIONS AVAILABLE FOR DIRECT DEBIT WITHDRAWALS, PLEASE SELECT ONE OF THE BELOW.

OPTION 1 - I WOULD LIKE TO PAY BY SAVING OR CHEQUE ACCOUNT:
ACCOUNT NAME
BSB NO
BANK
BRANCH
ACCOUNT NUMBER
OPTION 2 - I WOULD LIKE TO PAY BY CREDIT CARD:
NAME ON CARD
CARD NUMBER
EXP DATE
Transactions will appear on bank statement as a "Chubb Fire & Security" transaction