A form for service providers to nominate bank details to receive electronic payments.
Important: Please download this PDF to your computer. You can fill it in using Adobe Reader but it will not save if you attempt to fill it in using your web browser.
This form is for service providers to nominate their bank details to receive payments electronically.
By electing to receive payments via EFT you also agree to receive remittances electronically (by email).
If you have more than 1 provider number you need to complete a separate EFT application form for each number.