Change of Lessee & Direct Debit Form

Use the form below to submit a change of ownership of your current service. If submitting on behalf of the current owner please complete as much information as possible.

Transfer From:

Customer Account Name(Required)

ABN (If Business Account)

UBT Customer Code(Required)

Name of Current Owner:(Required)

First Last

Transfer Date(Required)

Email Address(Required)

Customer Account Number(Required)

Transfer To:

Do you have an existing Telco Billing Account?(Required)

Yes

Customer Account Name(Required)

ABN (If Business Account)

UBT Customer Code(Required)

(“you”) request and authorise UBT Marketing PTY LTD or its Assigns (Debit User Indentification Number 46112) to arrange, through its own financial institution, for any amount UBT Marketing Pty Ltd or its Assigns may debit or charge you to be debited through the Bulk Electronic Clearing System from an account held at the financial institution identified below and paid to the Debit User, subject to the terms and conditions of the Direct Debit Request Service Agreement and any further instruction provided below.

Insert the name and address of financial institution of your account

Financial Institution Name(Required)

Address(Required)

Street Address Address Line 2 State / Province / Region ZIP / Postal Code

Insert details of Bank Account

Name/s on Account(Required)

BSB Number(Required)

Account Number(Required)

By signing this Direct Debit Request you acknowledge having read and understood the terms and conditions governing the debit arrangements between you and UBT as set out in this Request and in your Direct Debit Request Service Agreement.

Name of New Owner:(Required)

First Last

Transfer Date(Required)

Email Address(Required)

Customer Account Number(Required)

Phones to be Transferred(Required)

Users Name

Phone (Service Number)

Enter the details of the Customer’s Name and Service Numbers to be transferred. Click on the + icon to add more rows.

Streamline3 Transfer(Required)

Phone (Service Number

Streamline3 Device Serial Number

Customer Code of Incoming Transfer

To find the Streamline 3 device serial number, Open the Apps folder on the device and then open the Streamline 3 app. The serial number will be displayed on the screen, starting with 250.

Digital Signature of Person Submitting Form:(Required)

Printing your First Name + Middle Initial + Last Name will act as your digital signature.