Online Direct Debit Form

Your Energy Account Details

Please enter your Black Box Power Account Name

Please enter your 7-10 Digit Account Number found on your bill

Please enter the Address of your Black Box Power account

Please enter the Suburb of your Black Box Power account

Please enter the name if your City or Region

Please enter your postcode

Please enter your day Phone Number

Please enter your evening Phone Number

This should be a valid email address

Your Bank Account Details

Please enter your Account Name

Account to be Debited

Please enter your 2 digit Bank Code

2 digits

Please enter your 4 digit Bank Branch Number

4 digits

Please enter your 7 digit Account Number

7 digits

Please enter your 2-3 digit Account Suffix

2-3 numbers depending on bank

To the Manager

Please enter your Bank Name eg. "ANZ"

Please enter your Bank Branch

Please enter your the Address of your Bank

Authorisation Code

Application Date

I/We authorise Pulse Energy Alliance LP (hereinafter referred to as the Initiator), using Authorisation Code 0227637, until further notice to debit my/our account with all amounts the Initiator may initiate by Direct Debit.

You must check this box to proceed

Information which will appear on your Bank Statement. For your information only. These particulars are fixed.

Payer Particulars

Payer Code

Payer Reference

Please select when you would like your Direct Debit to commence. (Answer is required)

Conditions of this Authority

I confirm that I have the sole authority for the bank account submitted in this application

You must check this box to proceed

If dual signatories are actually required, you cannot proceed with this paperless authority setup. A direct debit authority form is required to be signed by both signatories and returned. Please download and print the form here or contact us at 0800 269 769 to request a printed direct debit form and send it back to us at: Black Box Power, P.O. BOX 10044, Dominion Road, Auckland 1446.

Read the Conditions of this Authority here.

I accept the Conditions of this Authority.

You must check this box to proceed

CONDITIONS OF THIS AUTHORITY TO ACCEPT DIRECT DEBITS

1. The Initiator:

Has agreed to give advance Notice of the net amount of each Direct Debit and the due date of the debiting at least 10 calendar days (but not more than 2 calendar months) before the date when the Direct Debit will be initiated. This notice will be provided in writing (including by electronic means and SMS where the Customer has provided prior written consent (including by electronic means including SMS) to communicate electronically).
       The advance notice will include the following message:-
       "Unless advice to the contrary is received from you by (date*), the amount of will be directly debited to your Bank account on (initiating date)."
       * This date will be at least two (2) days prior to the initiating date to allow for amendment of Direct Debits.
May, upon the relationship which gave rise to this Authority being terminated, give notice to the Bank that no further Direct Debits are to be initiated under the Authority. Upon receipt of such notice the Bank may terminate this Authority as to future payments by notice in writing to me/us.

2. The Customer may:-

At any time, terminate this Authority as to future payments by giving written notice of termination to the Bank and to the Initiator by means agreed by the customer, Bank and Initiator.
Stop payment of any Direct Debit to be initiated under this authority by the Initiator by giving written notice to the Bank prior to the Direct Debit being paid by the Bank.

3. The Customer acknowledges that:-

This authority will remain in full force and effect in respect of all Direct Debits passed to my/our account in good faith notwithstanding my/our death, bankruptcy or other revocation of this authority until actual notice of such event is received by the Bank.
In any event this authority is subject to any arrangement now or hereafter existing between me/us and the Bank in relation to my/our account.
Any dispute as to the correctness or validity of an amount debited to my/our account shall not be the concern of the Bank except in so far as the Direct Debit has not been paid in accordance with this authority. Any other dispute lies between me/us and the Initiator.
Where the Bank has used reasonable care and skill in acting in accordance with this authority, the Bank accepts no responsibility or liability in respect of:-
– the accuracy of information about Direct Debits on Bank statements; and
– any variations between notices given by the Initiator and the amounts of Direct Debits.
The Bank is not responsible for, or under any liability in respect of the Initiator's failure to give notice in accordance with 1(a) nor for the non-receipt or late receipt of notice by me/us for any reason whatsoever. In any such situation the dispute lies between me/us and the Initiator.

4. The Bank may:-

In its absolute discretion conclusively determine the order of priority of payment by it of any monies pursuant to this or any other authority, cheque or draft properly signed by me/us and given to or drawn on the Bank.
At any time terminate this authority as to future payments by notice in writing to me/us.
Charge its current fees for this service in force from time-to-time.

Version PULSEDD_614010 Online