Instuction to your Bank or Building Society to pay by Direct Debit
Account Details
Items marked
must be completed
Use Of The Form
Form Ref. No.
349136
This form can be completed on-line.
When completed it should be printed and sent back to the Council.
Account Details
Name(s) of Account Holder(s)
Bank/Building Society account number
Branch Sort Code
Name and full postal address of your Bank or Building Society
Bank / Building Society
Address Line 1
Address Line 2
Address Line 3
City / Town
County
Postcode
Account Reference Number
Preferred Payment Date
This is not part of the instruction to your Bank or Building Society
I wish to pay monthly on or immediately after this date (select one from pull down list : 1st, 15th or 25th)
1st
15th
25th
If the 15th or 25th date is selected, payment will not be called for in March due to Annual Billing and the last payment will be adjusted to February.