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

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

Please enter your 4 digit Bank Branch Number

Please enter your 7 digit Account Number

Please enter your 2-3 digit Account Suffix

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.

I accept the Conditions of this Authority.

You must check this box to proceed

SPECIFIC CONDITIONS RELATING TO NOTICES AND DISPUTES

I agree that the initiator must give me at least 10 days’ notice prior to each direct debit, provided that where the direct debit is in a series, the Initiator is only required to provide 10 days’ notice prior to the first direct debit in the series.
Changes to the amounts or dates of a series of direct debits require 30 days’ prior notice to me.
I can also agree with the Initiator to receive a same day notice for direct debits specifically requested by me.
All notices must be in writing, but can be delivered electronically, if I have agreed that with the Initiator.
I can also ask you to reverse a direct debit up to 120 days after the direct debit if:
1. I didn’t receive proper notice of the amount and date of the direct debit, or
2. I received notice but the amount or date of the direct debit is different from the amount or date on the notice.
If you dishonour a direct debit but the Initiator retries it within 5 business days of the original direct debit,

I understand that the Initiator doesn’t need to notify me again about that direct debit.