The Direct Debit Request form can be used to change your bank account/credit card details, billing frequency or date of payment. It can also be used if you would like to change from Account Notice or Payroll deductions to Direct Debit payments.
Click here to download the Direct Debit Request form (165Kb PDF). Please ensure you read and understand the service agreement.
If you would like to cancel your Direct Debit contributions please fill in the cancellation form below. Please note that your membership payment will default to Account Notices. You can also use this form to cancel your Direct Credit for payment of benefits. Please note that your benefits will be paid via cheque.
Click here to download the Cancellation of Direct Debit/Credit form (60Kb PDF).
Please note: changes to your Direct Debit must be received in writing by us at least 14 days prior to your nominated date. Changes can only be made by the main member.
Fax your completed forms to: (08) 8113 2259
OR
Mail your completed forms to:
Health Partners,
Reply Paid 1493,
Adelaide SA 5001
(no stamp required)
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