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Direct Debit Request - Credit Card Details

I request and authorize CLONARD COLLEGE 153298 to arrange for any amount CLONARD COLLEGE may debit or charge to be debited through the Bulk Electronic Clearing System from the credit card identified below subject to the terms and conditions of the Card Online Payment Services Request Service Agreement (and any further instructions provided below).

Your name: *

Your email address: *

Please list all students enrolled at Clonard for whom you will pay fees: *

Your account number (available on your fee statement, where applicable): *

Bank name: *

Bank branch:

Credit card type: *

VISA

Mastercard

Credit card number (16 digits): *

Credit card expiry date (eg. 03/25): *

Name shown on credit card: *

Direct debit frequency: *

Monthly (to commence on February 20th, 2023)

Once per term (Term 1: 20/03/2023, Term 2: 20/06/2023, Term 3: 20/09/2023, Term 4: 20000/12/2023)

Direct Debit Amount:

The college will calculate a debit amount based on your nominated debit start date, your nominated debit frequency, and your account balance. Direct debit is ongoing, until written instruction is issued to stop the debit. It is your responsibility to ensure that there are sufficient funds to clear on the nominated date.

Please use this link to review the Direct Debit Request Service Agreement prior to completing the acknowledgement and signature.

Acceptance *

I acknowledge that I have read and understood the terms and conditions governing the debit arrangement between myself and CLONARD COLLEGE as set out in this Request and in the Direct Debit Request Service Agreement and that I accept those terms and conditions.

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