ELECTRONIC FUNDS TRANSFER AUTHORISATION

I hereby authorize Manly Warringah Basketball Assoc. to directly deposit my pay in the bank account listed
below. This authorization is to remain in force until MWBA has received written authorization from myself
of its termination or change.

Name Name First Last
Position
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number
Email
BANK ACCOUNT DETAILS
Financial Institution
BSB
Account Number
Declaration

Declaration I declare that the above information is correct and request that any payments to the abovementioned person be made to this account from the below date until otherwise notified.
Date Date / DD / MM YYYY

ELECTRONIC FUNDS TRANSFER AUTHORISATION

ELECTRONIC FUNDS TRANSFER AUTHORISATION

BANK ACCOUNT DETAILS