We’re so glad to have you onboard. We just need some personal details, and if your membership requires weekly payments, please fill in the Direct Debit Form details.
Date of Birth
Mobile Phone Number
Home Phone Number
Emergency Contact's Phone Number
Bank Account Name
Bank account number
AUTHORITY TO ACCEPT DIRECT DEBITS
(Not to operate as an assignment or agreement)
Authorisation Code: 0302448
I authorise you to debit my account with the amounts of direct debits from Waitakere City Stadium Trust with the authorisation code specified on this authority in accordance with this authority until further notice.
I agree that this authority is subject to:
- The bank’s terms and conditions that relate to my account, and
- The specific terms and conditions listed below.
I confirm that I have authority over this bank account, and that it can be operated severally.
Add any extra comments here