BNB Debit Form
All details are required.
Name *
Your answer
Date of Birth *
Your answer
Gender *
Postal Address *
Your answer
Email Address *
Your answer
Contact number *
Your answer
Emergency contact's name *
Your answer
Emergency contact's number *
Your answer
Name of bank *
Your answer
Bank account holder's name *
Your answer
BSB Number *
Your answer
Account Number *
Your answer
Debit frequency (I suggest choosing the same frequency that you get paid) *
Day or date for first debit to be taken (I suggest choosing the day of, or the day after your payday) *
Your answer
I agree & consent to the BNB Gym Rules and BNB Waiver found at the bottom of this page *
Required
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