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Bank Reconciliation Form BANK ACCOUNT DETAILSPayments cannot be made to credit card, loan or mortgage accounts.6). Name of Bank, Building Society or Credit Union_______________________________________________Branch where your account is held_______________________________________________Branch Number (BSB)-Account Number_______________________________________________Account Held in the Names of:______________________________________________________________________________________________CONSENTPeople over 14 have to sign to indicate consent for their payments.SignaturesDate:____/_____/_________SignaturesDate:____/_____/_________SignaturesDate:____/_____/_________SignaturesDate:____/_____/_________Internal Account Information:Complete this form if you would like to register and store your bank account details for the purpose of making payments to you.You can also register your bank account details:By calling xxxxxxxxIn person at your ___________________________Online At AssistanceIf you need help completing this from call _____________ or visit LodgmentSend this completed form to: _______________________YOUR DETAILS 1). Bank card Number--Reference No.2). DrMrMrsMissMsFamily Name: ________________________________First Given Name: _____________________________ 3). Date of Birth: ____/____/__________ 4: Postal Address: _______________________________ __________________________________________________________________Postal Code__________________5). Daytime Phone Number: _______________________Email: _________________________________________ ................
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