Credit Card Or Direct Debit Authority

Credit Card Or Direct Debit Authority (CCDA)

Enter Your Details

Company Name

ClickPOS Login

Contact Name

Telephone Number

Enter Authority Details

Direct Debit Authority

Credit Card Authority

Fill this section if you want to make payments using your bank account eg Cheque or Savings.
(for Accounts held in Australia only)
I/We request CLICKPOS PTY LTD to arrange for funds to be debited from my/our nominated account.

Financial Institution

Account Name

Account Number

BSB Number

Do you have a second account holder for this account?

Fill this section if you want to make Payment using your CREDIT CARD
I request CLICKPOS PTY LTD to arrange for funds to be debited from my nominated credit card.
NOTE: Payments by credit card will incur a card surcharge fee of 1.5%

Card Type

Visa Master Card Bank Card

Card Number

Card Expiry Month

Card Expiry Year

Card Holder Name

Please Sign Below (with Mouse or Touchscreen)

Secondary Account Holder - Please Sign Below (with Mouse or Touchscreen)