New pre-approval for BACK PADDOCK COMPANY PTY LTD

Business Information

BACK PADDOCK COMPANY PTY LTD
ABN: 65094019619
Unit 1, 13-15 Steel Street
Capabala , QLD , 4157
Australia
bpollard@backpaddock.com.au
07 3220 2959

Pre-Approval agreement for BACK PADDOCK COMPANY PTY LTD to be given authority to debit - new customers only

By completing this form, you agree for BACK PADDOCK COMPANY PTY LTD to debit using your chosen method of payment. Upon completion, you will be sent a confirmation by email together with instructions on how to cancel this pre-approval if required. Future payments will be debited automatically and payment frequency and amounts are at the discretion of BACK PADDOCK COMPANY PTY LTD.

Please note this form is for NEW BACK PADDOCK COMPANY PTY LTD customers only, if you are an existing or returning customer of BACK PADDOCK COMPANY PTY LTD please get in touch with us and ask for a different link.

The frequency and amounts of future payments will be determined by BACK PADDOCK COMPANY PTY LTD based on your completed purchase orders. The value of your purchase order will be influenced by the current prices for laboratory product samples, which are accessible within the app, along with the number of samples requested. This form is designated solely for new customers of BACK PADDOCK COMPANY PTY LTD. If you are an existing or returning customer, we kindly request you contact us for an alternative link.

You also acknowledge that you have read the Terms and Conditions by clicking here.

How would you like to pay?

Credit / Debit Card ( 1.95 % plus 30c added to each transaction )

Bank Account ( 1.0 % plus 30c with a maximum fee of AUD 5.00 )

Credit Card Details

All fields are required unless marked as optional.

Company Name (Optional)

First Name

Last Name

Address Line 1

Address Line 2 (Optional)

City

State

Postcode

Email Address

Card number (no dashes or spaces)

Security Code

Exp. Month

Exp. Year

Name (as it appears on your credit card)

Bank Account Details

All fields are required unless marked as optional.

Company Name (Optional)

First Name

Last Name

Address Line 1

Address Line 2 (Optional)

City

State

Postcode

Email Address

BSB Number

Account Number

Bank Account Name

**By entering this agreement, you approve BACK PADDOCK COMPANY PTY LTD to debit the nominated bank account above.

By submitting you acknowledge that you have read the Direct Debit Request Service Agreement by clicking here. A copy of the DDRSA and your completed DDR will be emailed to you for your records.