Direct Debit Request Form

Are you a residential customer or a business customer?

Residential

Business

Full name

Preferred Contact Method

Phone

Type of Identification

Identification Number

Date of birth

Business Name

Full Name

Position held

Email Address

Phone

Add a second person

Full Name

Position held

Email Address

Phone

Your Aurora Energy Account Number

Bank Account Name(s)

Bank Name

Bank BSB Number

Bank Account Number

Direct Debit arrangements

If you have outstanding amount at the due date you will need to make a manual payment

If you have an outstanding bill, would you like to make payment using this application form?

Yes

Payment Frequency

Amount $

Date of commencement

I understand the total amount of my bill will be debited on the due date of each bill

Consent to Direct Debit T&C's & Privacy Statement

Terms and conditions
I/we declare that the details provided above are correct and authorise Aurora Energy Pty Ltd (User ID No. 029022) to arrange for funds to be transferred from the account at the financial institution identified above. I/We agree to the terms as set out in the Direct Debit Request Service Agreement.

Privacy Statement
By submitting this online form you acknowledge and understand the way Aurora collects, uses and discloses your personal information as set out in our privacy collection statement.

I wish to receive my bills via email

Yes

Email address for billing

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Account management tools

Before you proceed.