Debt Collection Specialists | Sydney | LCollect
Debt Collection Agency | LCollect

Direct Debit Request Form

Review and confirmation Direct Debit Request Service Agreement

By agreeing to a direct debit facility, you authorise and request LCollect Pty Ltd (Direct Debit Identification No. 304262) to debit your nominated account through BECS:

Account Name:
BSB Number:
Account Number:
Financial Institution (Bank):  ()

You have also agreed to pay in instalments the first of which will be debited on and then subsequently on the of each .

You understand that LCollect Pty Ltd will debit your account in accordance with the payment arrangement between you and LCollect Pty Ltd and that both parties will be bound by the terms and conditions set out in the Direct Debit Request Service Agreement which we will make available to you.

A copy of our Direct Debit Request Service Agreement can be downloaded below:

Direct Debit Request Service Agreement Direct Debit Request Service Agreement (39 KB)

Are you satisfied to proceed with these payments to be debited from your account?
Yes | No


Electronic Direct Debit Request Form

Please complete the below fields to make payments using Direct Debit. We recommend completing this form at a desktop PC using Internet Explorer, Google Chrome or Mozilla Firefox.

* Required fields

Your details

Debit details



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