St John the Baptist Outside School Hours Care 7 Johnson Street, Freshwater NSW 2096 T: 0427 716 593 E: freshwater.oshc@dbb.org.au W: Direct debit request I request and authorise CatholicCare Broken Bay to debit my Nominated Account with the amounts due for / / Outside School Hours Care commencing on and fortnight thereafter. I understand that the amount charged may vary as determined by my level of use of the service. I understand this request is in place until I discontinue my use of the service and provide CatholicCare that I wish to cancel this request giving two weeks written notice from effective date. Bank account Financial institution name: Branch: Account name in full: - BSB: Account no: Credit card Cardholder name: Name on card: Credit card number: / CCV: Expiry: Authorisation / / Name Signature Date Office use only / / / / Employee name: Date received: Date processed:
St John the Baptist Outside School Hours Care 7 Johnson Street, Freshwater NSW 2096 T: 0427 716 593 E: freshwater.oshc@dbb.org.au W: Direct debit request I request and authorise CatholicCare Broken Bay to debit my Nominated Account with the amounts due for Outside School Hours Care commencing on / / and fortnight thereafter. I understand that the amount charged may vary as determined by my level of use of the service. I understand this request is in place until I discontinue my use of the service and provide CatholicCare that I wish to cancel this request giving two weeks written notice from effective date. Bank account Financial institution name: Branch: Account name in full: BSB: - Account no: Credit card Cardholder name: Name on card: Credit card number: Expiry: / CCV: Authorisation / / Name Signature Date Office use only Date received: / / Date processed: / / Employee name:
St_John_the_Baptist_OSHC_Enrolment_Form.docx