Direct debit application

Direct Debit application

Originator's Identification Number: 930075

You can pay your bill by direct debit – it’s the easiest way to pay. Please complete this form to submit your application.

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Your details

Customer Account Number (As shown on your bill)*: Customer Account Holder Full Name*: Bank Account Holder Full Name: Bank Account Number*: Sort Code Number*: Bank Branch's Address*: Does the property have a water meter?*: Yes No Please debit me*: once a year, on the 1st April twice a year, on the 1st April and 1st October monthly, on the 1st of the month monthly, on the 8th of the month monthly, on the 15th of the month monthly, on the 22nd of the month Occupier's Name: Occupier's Address: Occupier's Telephone Number: Occupier's Email Address*: Number of Occupants:

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Direct debit application

Direct Debit application

Your details