HSBC Credit Cards
Direct Debit Request
Complete the form using blue or black pen and print in clear CAPITAL LETTERS
ADDITIONAL TERMS
• Complete this form to make regular payments via a direct debit to your credit card from your nominated account below.
• Make sure you have enough money in your nominated account so we can take the regular payment.
• If you don’
t choose which portion of the bill you’d like paid, we will automatically process the minimum payment.
• If you choose to pay the full balance, this will pay out all you owe (except any special promotions that aren't balance
transfers, which we'll take the minimum payment for these).
• The amount we’ll take is calculated at your statement date.
• If you make any extra payments before we take the payment, this will change the amount we're due to take. We won't take
any payment if the amount we're supposed to take is more than all you owe.
• You need to make manual payments until we tell you we've set up the regular payment arrangement.
• We'll take payments until you've paid all you owe and no longer have a credit card account with us or you ask us to cancel
your direct debit request and we've processed your request.
• More information on direct debit payments can be found in the Personal Banking Booklet and these terms are in addition
to those terms.
Fax to: (02) 8987 5923
OR
Mail the completed form to: Reply Paid 4263, SYDNEY NSW 2001
PRIMARY CARDHOLDER DETAILS
HSBC Credit Card number
Home phone number
( )
Work phone number
( )
Mobile phone number
First name(s)
Surname
REGULAR PAYMENT OPTIONS
Which portion of the bill you would like paid automatically each month?
Minimum monthly payment due Full balance each month Pay a fixed amount each month $
I authorise HSBC to take payments from my nominated account below to pay my credit card payments, and understand this
will begin one month after I first use my credit card.
Name and address of financial institution
Name of nominated account holder
Account numberBSB number
REQUEST AND AUTHORITY TO DEBIT
Signature Date
DD MM YY
By signing below, I'm confirming that the above information is correct and that I've signed in accordance with the authority for
the nominated account the payments will be taken from.
Signature
Date
DD MM YY
AUTHORISATION
HBAA517VCC 07/20
Credit provided by HSBC Bank Australia Limited ABN 48 006 434 162 Australian Credit Licence 232595
On completion of this form,
please print and sign by hand
On completion of this form,
please print and sign by hand
