Direct Debit Request and Service AgreementDirect Debit Request and Service Agreement • April 26th, 2017
Request and authorise St. Luke’s Medical and Hospital Benefits Association (13665) to arrange for any amount St. Luke’s Medical and Hos- pital Benefits Association may debit or charge you to be debited through the Bulk Electronic Clearing System from an account held at the financial institution identified below subject to the terms and conditions of the Direct Debit Request Service Agreement.