Application for membership – Bank account direct debit

Please complete your details below
 Employer number
 Date of birth
 First name
 Middle name
 Home address
 Home phone
 Email address
 Repeat email
 Team / Department
 Work address
 Work postcode
 Work phone
 Work fax
 Hours worked per week
 Are you
 Are you interested in becoming a workplace rep or contact?
Account information – fortnightly direct debit from bank account
 Bank name
 Account name(s)
 Account number
 Application agreement
 Direct Debit Customer Authority
I have read, understood and agree with the above Application Agreement and Direct Debit Customer Authority and wish to make application to become a member of the CEPU
Share this