Free Shirt

Complete the form below and click 'submit'.

You DO NOT have to submit both your Credit Card and Bank Account information. Choose only one option.

Forms must be submitted before 1st December 2020.
Your switch to Direct Debit will begin 1st January 2021.
Your free shirt will then be sent to you before 31st January 2021.


Free Shirt Form

Name:

Shirt Size:

Date of Birth:

Address:

Phone / Mobile Number:

Post Code:

Your Email:

Gender:

Employed by (company name, or name of employment agency)

Employer Location:

Employment Status:

Shift: (your regular work hours):

Work Area:


Direct debit authority

By filling in this section, you are authorising the Union to take your union fees from your bank account automatically.

I/We (Account Holder Name(s)):

hereby authorise the AMIEU (APCA User ID Number: 061436) and request that you, until further notice in writing, debit my/our account described in The Schedule below any amounts which the Australasian Meat Industry Employees' Union 064136 may debit or charge me/us through the Direct Debit System.

I/We understand and acknowledge that:

  1. The financial institution may, in its absolute discretion, determine the order and priority of payment by it of any monies pursuant to this request or any authority or mandate;
  2. The financial institution may, in its absolute discretion, at any time by notice of writing to me/us terminate this request as to future debits;
  3. The user may, by prior arrangement and advice to me/us, vary the amounts or frequency of future debits.

The Schedule

All details must be supplied.

Name of Financial Institution:

Account Name(s):

BSB Number:

-

Account Number:

Direct Debit Option:

Note: If no choice is made, the default direct debit is weekly on a Wednesday. Monthly direct debits are taken on the 1st business day of each month.


Credit card authority

By filling in this section, you are authorising the Union to take your union fees from your credit card automatically.

I/We (Card Holder Name(s)):

hereby authorise the AMIEU and request that you, until further notice in writing, debit my credit card as described in The Schedule below any amounts which the Australasian Meat Industry Employees' Union 064136 may debit or charge me through their Bank Merchant Facility.

I understand and acknowledge that:

  1. The financial institution may, in its absolute discretion, determine the order and priority of payment by it of any monies pursuant tot his request or any authority or mandate;
  2. The financial institution may, in its absolute discretion, at any time by notice of writing to me terminate this request as to future charges;
  3. The user may, by prior arrangement and advice to me, vary the amounts or frequency of future charges

The Schedule

All details must be supplied.

Name on Card:

Credit Card Number:

Expiry Date:

CCV/CVV Number:

Payment Option:

Notes:

  1. If no choice is made, the default option is Monthly.
  2. A pro-rata charge will be made to your credit card when your membership application is received. Please contact the office if you wish to know how much this pro-rata amount will be.
  3. After the initial pro-rata charge your following credit card payments will be taken on the 1st day of each month, for Monthly payments, or the 2nd of January and the 1st of July if paying 6 Monthly payments. If the scheduled day lands on a weekend or a public holiday, it will occur on the next business day.

Declaration

I hereby declare the above information to be true and correct.


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