EzyPay Online Form Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Contact Phone *Postal AddressDate of BirthPayment Information *Recurring PaymentOne off PaymentAmount *Please note that the minimum recurring payment amount is $25 per weekFrequencyMonthlyFortnightlyWeeklyStart DatePayment MethodBank AccountCredit/Debit Card (we will call you to take details over the phone)BSB & Account NumberTerms and Conditions Please Enter Initials to Indicate You've Read ThemYou will be charged by our third-party billing service Ezipay on a weekly basis. You can find the details of the company below. Should you need to change your credit card details please do let us know in advance as there is a failed payment fee of $9.79 which charged. you can contact directly or call Ezpay on the number below. $0.36 + 1.7490% of the debit amount is charged for every transaction Customer Service Hotline Hours: 8am – 6pm (AEST) Australia | 1300 300 553 | help@ezypay.com New Zealand | 0800 399 420 | nz.help@ezypay.comSignatureI have read and understood the terms and conditions listed above and consent to EziPay deducting the agreed amount on the agreed date as listed above.NameDateSubmit
