Affiliate Account Direct Debit Form

Thank you for choosing National Custom Compounding as your Affiliate compounding pharmacy.

As part of the onboard and setup process, our business requires that you complete the following Direct Debit form to allow us to setup a 14-day business account for your transactions.

Please note that direct debit will occur 14 days after the end of month.

All account documentation will be emailed through to the account payable email address that was initially provided during the Affiliate registration.

Please complete the Direct Debit form via Westpac, Payway.

Complete the NCC Direct Debit Form here

Terms and Conditions can be viewed below.

Customer Direct Debit Request (DDR) Service Agreement

If you would prefer to manually complete the form, please download it below. You will then need to email a signed and completed copy to the team [email protected]