Get Direct Credit Request Form - Latrobe Health Services

Completing the Direct Credit Request Form for Latrobe Health Services involves filling out various sections accurately to ensure smooth processing of payments. This guide provides simple and clear instructions to help users navigate the process effectively.

Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to access the Direct Credit Request Form and open it in your preferred document editor.
2. In Part A, enter the hospital details. Provide the hospital name, provider number, mailing address, suburb, state, phone number, fax number, email address, website, and postcode.
3. Move to Part B to input bank details. Authorize payments to be made by direct credit to your specified account by filling in the account holder's name, financial institution, BSB number, branch, effective from date, account number, and an email address for remittance advice.
4. In Part C, read the declaration statement carefully. If all information provided is correct, sign your name and date the form to confirm your authorization of direct credit payments as per the provided details.
5. Once all sections are completed, save your changes. You may choose to download, print, or share the form as required, before forwarding it as an email attachment to hcenquiry@lhs.com.au.

Complete your forms online to ensure efficient processing and ease of management.