Creditor Application

"*" indicates required fields

Creditor Application ID

Leeton Shire Council facilities to credit payments directly into your nominated bank account. This application is to be completed by all creditors.

Creditor Name*

Postal Address*

Street Address City State Postcode Country

ABN

Registered for GST

Yes

Phone*

Email*

Contact Name*

First Last

Contact Position*

Email for remittance*

Name of staff member you've been in contact with

Submission Date

Bank Details

Note: You will be contacted by EFTSURE to verify your bank details by phone or email. Please ensure you respond when contacted as we are unable to deposit funds to your account until this process has been completed.

BSB*

Account Number*

Account Name*

Name

This field is for validation purposes and should be left unchanged.