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Authority to Accept Direct Debits

Not to operate as an assignment or agreement.

Complete the fields below or alternatively download the Authority to Accept Direct Debit form. Please freephone 0800 10 22 76 with any enquiries.

* Denotes required field.

Account Details
Account number is mandatory and must be numeric. Use the + button to add more accounts.
Start typing your address, then select from the options shown or enter your address manually.
If different from mailing address above.
Please advise any other level of account authority on this account.
Bank Details
We will contact you regarding verification of your bank account details.
Payment Details
Maximum 12 characters
Maximum 12 characters
Maximum 12 characters
Acknowledgement

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