Home
My account
Request direct debit

Request direct debit

Please complete the form below to set up direct debit payments. If you need any help, you can call us on 1300 650 803 (national) or 1300 364 264 (South Australia).

Step 1

Would you like to set up a new direct debit or manage an existing one?

Step 2

How would you like to pay for your direct debit?

To set up a direct debit by credit card, please call us:

08 9242 0242 - metro callers
1300 650 803 - country callers

Return To My Account

Fill up to form below to request a direct debit via your bank account

Step 3

Your information

Account type

Customer reference number*

First name*

Last name*

Email address*

Phone number

Street address*

Suburb*

Care option*

Select your state*

Details of the bank account to be debited

Account name*

BSB*

Name of financial institution

Account number*

Details of debit*

When would you like your direct debit to commence?

How much would you like to pay?*

Total amount when due Regular installments

Would you like to receive your account via email?*

Yes No

I understand that my personal information will be collected as set out in our privacy collection statement and in line with Silverchain’s Privacy Policy.

Your personal (including sensitive) information (Your Information) will be collected and used by Silver Chain Group Limited and its related companies (collectively Silverchain, we, us or our) to process your direct debit payments. We may disclose Your Information to other persons and organisations including to our related companies and service providers. Some of these service providers may be located overseas and Your Information may be held or disclosed overseas. A list of the countries in which these service providers are located is available here. If you do not provide your information, we may be unable to process your payment.

Please refer to Silverchain's Privacy Policy for more information about how we handle Your Information including how to seek access to or correct your information or submit a privacy complaint and how that complaint will be handled.

You can contact us on 1300 650 803 if you have any queries about the manner in which we handle your information.

Step 4

reCAPTCHA

Summary