Setup Direct Debit
Set Up Direct Debit for Your Pharmacy Account
Download the correct form for your state, complete it, and return it to us. We will handle everything else.
Select Your State
Download the direct debit authority form for your state, complete it, and email it back to us.
New South Wales Customers
If you are from New South Wales and would like to set up Direct Debit payments for your Pharmacy Account, please download the forms below, fill in your details, sign and send back to us via email to carltonpharmacy@gmail.com
Queensland Customers
If you are from Queensland and would like to set up Direct Debit payments for your Pharmacy Account, please download the forms below, fill in your details, sign and send back to us via email to carltonpharmacy@gmail.com
How to Submit Your Form
Step 1: Download
Download the correct form for your state using the buttons above.
Step 2: Complete
Fill in all required fields and sign the form where indicated.
Step 3: Email
Scan or photograph the completed form and email it to carltonpharmacy@gmail.com.
Step 4: Confirmation
We will process your direct debit authority within 2 business days and send you a confirmation.
Need Help Setting Up Direct Debit?
Our team is happy to assist. Call us or send an email and we will guide you through the process.