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PREAUTHORISED DEBIT PAYMENT - AUTHORISATION AGREEMENT FRANCE

Important notice s: - Any new customer joining the SWIFT Services is required to register to the direct debit mechanism for the payment of all its SWIFT invoices. - To speed up the activation of your direct debit, please complete the form

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PREAUTHORISED DEBIT PAYMENT - AUTHORISATION AGREEMENT FRANCE

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  1. Important notices: - Any new customer joining the SWIFT Services is required to register to the direct debit mechanism for the payment of all its SWIFT invoices. - To speed up the activation of your direct debit, please complete the form and request your correspondent bank to stamp and sign for approval prior to returning to SWIFT. Numéro National d’Emetteur PREAUTHORISED DEBIT PAYMENT - AUTHORISATION AGREEMENT FRANCE This form is drafted in compliance with the French Market Standards for Direct Debits We, hereinafter called Customer, authorise S.W.I.F.T. s.c.r.l., to originate and transmit electronic debit and credit entries in EUR to our account indicated in this agreement. A prenotification will be sent seven days before actual debiting/crediting of bank account (by MT999, fax or mail). Customer understands that a debit entry will only be accepted if sufficient funds are available in Customer’s bank account. In the event an invoice/credit note is not accepted for any reason, the Customer is to notify S.W.I.F.T.s.c.r.l.within 30 days of invoice date by creating a case online or forwarding a mail to collection@swift.com. DEMANDE DE PRELEVEMENT (Request for Direct Debit) Créancier Débiteur Customer Name : SWIFT Customer id No. : Address : Zip Code : City : E-mail: S.W.I.F.T. s.c.r.l. Avenue Adèle 1 B-1310 La Hulpe VAT: BE 413.330.856 Nom, adresse de la Banque du Débiteur Compte à Débiter (Account to be debited): Codes clé Etablisst Guichet N. du Compte RIB (Please respect the maximum number of digits) AUTORISATION DE PRELEVEMENT (Authorisation for Direct Debit) J’autorise l’ établissement teneur de mon compte à prélever sur ce dernier, si sa situation le permet, tous les prélèvements ordonnés par le créancier désigné ci-dessous. En cas de litige sur un prélèvement je pourrai en faire suspendre l’exé- cution par simple demande à l’ établissement teneur de mon compte. Je règlerai le différend directement avec le créancier. 441655 Créancier Débiteur Customer Name : SWIFT Customer id No. : Address : Zip Code : City : E-mail: S.W.I.F.T. s.c.r.l. Avenue Adèle 1 B-1310 La Hulpe VAT: BE 413.330.856 Nom, adresse de la Banque du Débiteur Compte à Débiter (Account to be debited): Codes Clé Etablisst Guichet N. du Compte RIB (Please respect the maximum number of digits) Date: Stamp and Signature: Please return the original form to: S.W.I.F.T. s.c.r.l., Credit and Collection, Avenue Adèle 1, B-1310 La Hulpe, Belgium Telephone: +32 2 655 35 67 - Telefax: +32 2 655 37 43 - SWIFT BIC: SWHQBEBBFIN - Version 5 December 2003 - Page 12

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