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Direct Debit Registration for New SWIFT Services Customers

Important notice for new customers of SWIFT Services: To facilitate payment of all invoices, registration for the direct debit mechanism is required. This authorization agreement allows SWIFT to debit funds electronically from your specified bank account in the United States. A prenotification will be sent seven days prior to any transactions. If an invoice or credit note is disputed, please contact SWIFT within 30 days. Complete and return this agreement to initiate the process.

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Direct Debit Registration for New SWIFT Services Customers

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  1. Important notice: Any new customer joining the SWIFT Services is required to register to the direct debit mechanism for the payment of all its SWIFT invoices. PREAUTHORIZED DEBIT PAYMENT - AUTHORIZATION AGREEMENT PREAUTHORISED DEBIT PAYMENT - AUTHORISATION AGREEMENT UNITED STATES Customer Name : SWIFT code (BIC or PIC): Address : City :Country : E-mail: We, hereinafter called Customer, authorise S.W.I.F.T. s.c.r.l., to originate and transmit electronic debit and credit entries in USD 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. Authorisation Authorised signature : Name : Title : Date : Authorisation Authorised signature : Name : Title : Date : Please indicate below the details of your USD account in the United States. Correspondent Bank Name (or BIC code) ABA number (9 digits) : Bank Account number: Person/Dept. we may contact for possible questions: 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 16

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