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Direct Debit Arrangement

Please fill out this form to set up a direct debit arrangement for your debt. We will action your request as soon as possible and email you when it's done.

Note:

Fields with an asterisk are required.

Please review the terms and conditions of this Authority which can be found here and our Privacy Policy available here.

Please only use New Zealand bank account details. This form does not accept debit or credit cards.

Your direct debit may appear on your statement as INTERCOLL LEDGER LIMITED, which is our legal billing name banks use for statements.

1. Enter your details

CCID / Reference number*

First name*

Middle name(s)

Last name*

Email*

Phone number*

Postal Address*

Suburb*

City / region*

Country*

Post code*

Date of Birth*

WINZ number

Employer name (if applicable)

Employer address (if applicable)

2. Payment Details

I agree to the payment arrangement set out below with Intercoll Ledger Limited in respect of the debt(s) I owe to Intercoll Ledger Limited. This payment arrangement is instead of paying the full amount of the debt immediately.

I agree to execute a direct debit authority in favour of Intercoll Ledger Limited to allow them to debit my account directly. The details of the payment arrangement/authority are detailed below.

I can cancel this arrangement and the direct debit authority at any time for any reason by contacting my bank or Intercoll Ledger Limited.

I accept that there could be consequences of cancelling, including that I may need to immediately repay the debt or Intercoll may without further notice bring legal proceedings against me for this / these debt(s).

Name of account holder*

Bank account number
(Dashes added automatically. No debit or credit cards. NZ accounts only)*

Amount to pay*

Frequency*

Start date*

3. Declarations

By signing up to this paperless authority, I authorise Intercoll Ledger Limited using Authorisation code 0235575 and 0235583 until further notice to debit my account with all the amounts the initiator may initiate by Direct Debit.

I accept the terms and conditions of this Authority which can be found here and in the link at the top of this form.

Intercoll Ledger Limited will not charge any fees for this payment arrangement.

I acknowledge that my personal information will be held and used as set out in the privacy policy.

I agree to the following:

(a) Full liability for the following debt as at the date of this document.

(b) Receiving electronic marketing materials and communications from Intercoll Ledger Limited, or their assignee, including emails and text messages

(c) The amount of each repayment can be increased annually on or about 1 June by the sum of $1.00 per repayment. The new amount will apply from June to May, and then each amount may be increased again each year until my debts are repaid.

(d) If I owe Intercoll Ledger Limited any other debt now or later (for example, other debt owed by me is assigned by the original lender to Intercoll Ledger Limited), I agree that this repayment arrangement also applies to that other debt, and authorise Intercoll Ledger Limited to continue to debit my account with the repayment amounts until all debts to Intercoll Ledger Limited are repaid. Intercoll Ledger Limited will notify me of the new number of payments needed to repay my debts. I agree that Intercoll Ledger Limited may split each repayment and apply it to each of my debts. Intercoll Ledger Limited will advise me before it does this. I can tell Intercoll Ledger Limited how I would like the repayments split.

(e) Intercoll Ledger Limited will cancel my payments when all of my debts have been repaid.

(f) I consent to receiving ongoing information in relation to my debts (information required to be provided to me by Section 19 of the Credit Contracts and Consumer Finance Act 2003 including my balances and repayments through the DebtManagers website (www.debtmanagers.co.nz) or through a request by email or phone.

(g) I understand that I will not receive regular statements by post or email.

(h) I authorise Intercoll Ledger Limited to reduce some or all repayment amounts or to change the day of my payments if my payments are being dishonoured. I also authorise Intercoll Ledger Limited to change the day of payment if public holidays are likely to interfere with my ability to pay

4. Email / Postal Address for Service

I agree that any communications, notices, statements of accounts, disclosures (including any required under the Credit Contracts and Consumer Finance Act 2003) and service (including the service of any legal proceedings) in connection with:

(a) This payment arrangement;

(b) Any other payment arrangement, loan, or other debt owed to the Intercoll Ledger Limited (whether by assignment or otherwise), whether entered into before or after this payment arrangement; and

(c) Any other payment arrangement, loan, or other debt that the Intercoll Ledger Limited may be collecting on behalf of a third party whether entered into before or after this payment arrangement;

(d) May be validly sent or served to me in person, electronically or by post to either the mobile number, the email address or postal address (which may include a post office box address) I have provided above;

(e) I understand that this agreement in relation to communications etc extends beyond this payment arrangement and shall survive termination or expiration of this payment arrangement (including through repayment). I agree that this agreement can be assigned to third parties to whom I owe money (even if such debt arises after the date of this agreement);

(f) I agree to advise Intercoll Ledger Limited of any changes to my mobile number, email address or postal address and that if I fail to do so I will still be treated as having received copies of all relevant documents provided to a number or an address listed above.

1. Enter your details 2. Payment Details 3. Declarations 4. Email / Postal Address for Service

Enquiry forms

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New Zealand contact information

Contact

0800 683 738 hello@debtmanagers.co.nz

Address

Private Bag 92027
Victoria Street West
Auckland, 1142

Hours

Monday – Friday
7am – 8pm

Media Enquiries

Malcolm Phillipps
Head of Strategic Partnerships and Engagement
malcolm.philliipps@debtmanagers.co.nz