Page 1 of 2
Special Payment Arrangement
Please check to indicate your agreement with the following.
At Trust Children, we understand that each family’s circumstances are unique.
*
This form requests a change to Trust Children's standard payment processes.
Service Agreement variation
*
Our service agreement requires that changes are agreed upon in writing by both parties.
Structure of the Arrangement
*
This arrangement allows services to be invoiced in 'blocks', with agreed supports delivered over the duration of the block.
One invoice is issued per service block on the day of first scheduled session.
Payment will be debited from your nominated account five (5) days after the invoice is issued, allowing time for any applicable claims to be processed before payment is collected.
Administrative Contribution
*
A 13% administrative contribution applies to each service block.
This contribution supports the additional administration required to coordinate, monitor and manage customised payment schedules.
Agreement
*
I have read and understood the details above
I agree to the terms of this Special Payment Arrangement
You may request to revert to Trust Children standard payment process (payment on day of service) at any time.
Parent / Caregiver name
*
Child name(s)
*
Submit
