Direct Debit or Credit Card authority
Your Nova Energy account details
Name/s of Nova Energy account holder (“customer”) – Please print
Name 1
Name 2
Nova Energy account number(s) to be paid by this authority
This can be found on your Nova Energy bill. Please include all additional accounts to be paid by this authority in the spaces below
1.
2.
3.
Address
Phone numbers
Home
Work
Mobile
Email
Credit Card authority only complete this section if you wish to pay by credit card
Card number
Expiry date
Card type:
Visa
MasterCard
American Express
I confirm I am the authorised signatory on this credit card. I authorise Nova Energy Limited to debit my Credit Card for all amounts
owing for my monthly bill.
Signed
Date
/ /
Direct Debit payment details please complete this section if you wish to pay by direct debit
Variable amount (pay your total due on the due date)
Fixed (fixed amount that you wish to have debited)
Starting date
/ /
Please allow up to 14 days for
processing
Frequency:
Weekly
Fortnightly
Monthly
Fixed Amount
$
Amount (in words)
Direct Debit authority
Name of my account to be
debited (acceptor)
Account number
Bank Branch Account Number Suffix
Name of my Bank
Please include the following information on my bank statement:
From the acceptor to [insert name of acceptor’s bank] (my bank):
I authorise you to debit my account with the amounts of direct debits from Nova Energy Limited 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 overleaf.
Signed
Date
/ /
Signed
Date
/ /
Please note that all Credit Card authorities need to be returned by post not via email
For a Credit Card Authority please post to Nova Energy, PO Box 404, Whakatane 3158.
For a Direct Debit Authority please email to info@novaenergy.co.nz or post to Nova Energy, PO Box 404, Whakatane 3158.
If you have any questions about joining Nova Energy or filling in this form, please call us on 0800 668 236.
Initiator’s Authorisation
Code
0608118
Approved
nnnn mm/yy
Specific conditions relating to notices and disputes
I may ask my bank to reverse a direct debit up to 120 calendar days after the debit if:
I don’t receive a written notice of the amount and date of each direct debit from the initiator, or
I receive a written notice but the amount or the date of debiting is different from the amount or the
date specified on the notice.
The initiator may only send a direct debit if you have:
asked the initiator to send it, and
agreed the amount of the direct debit.
The initiator is required to give you a written notice of the amount and date of each direct debit no less
than the date of the debit.
If the bank dishonours a direct debit but the initiator sends the direct debit again within 5 business
days of the dishonour, the initiator is not required to give you a second notice of the amount and date
of the direct debit.
Conditions of This Authority to Accept Payments by Credit Card
Terms & Conditions
1. These Terms and Conditions are to be read in conjunction with Nova Energy Limited’s Standard
Terms and Conditions for energy supply. Nova Energy Limited may be referred to in these Terms
and Conditions as “we” or “us”. By registering an Authority with us you acknowledge that you
have understood these Terms and Conditions and agree to be bound by them.
2. Credit card payment may not be available on all pricing plans.
3. We reserve the right to terminate any Authority and require you to pay your energy bill by an
alternative method.
4. You may set up an Authority for a credit card which is not in the Nova Energy account holder’s
name, but the card holder must sign the Authority.
5. We may ask the credit card issuer to verify the signature provided on the Authority.
6. Payments will continue to be made in accordance with the Authority until you advise us
otherwise. We will endeavour to cancel the Authority with immediate effect but there may be
circumstances where we are unable to cancel the next payment scheduled.
7. Should your payment be dishonoured by your credit card issuer, we may charge you a dishonour
fee.
8. We reserve the right to request a manual authorisation from your credit card issuer at any time.
9. You are responsible for updating your Authority details with us when your credit card expires.
10. You are responsible for updating your details when you change credit card issuers or receive a
replacement credit card with a new card number.
11. We will make any refunds to a nominated bank account, not to your credit card.
12. We use a security company to validate all credit card transactions.
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome