I/We request and authorise the City of Belmont (APCA User ID 067205) to arrange through its own financial institution a debit to the above nominated account, an amount agreed upon with the City of Belmont.
This debit will be made through the Bulk Electronic Clearing System (BECS) from this account held at the financial institution nominated above and will be subject to the terms and conditions of the Prepaid Direct Debit Agreement.
By accepting below, I/we agree to the direct debit arrangement.
Authorisation *