Welcome to Regency Fitness

Things to know:


  • A beeZ card and gym consultation will be required before your gym membership can be used. Please be advised there is a £20 joining fee which will need to be paid on your first visit.

  • If you think you qualify for a concession membership, please contact the leisure centre prior to signing up.

    We’re looking forward to see you.


Preferred Venue

Personal Details
Title *
First Name *
Last Name *
Date of Birth *




Address & Contact Details
Company Name
(if applicable)
House Name/Number *
Postcode *
Telephone *
Mobile Phone *
(if not available please repeat first telephone number here)
E-mail *
Confirm E-mail *


Bank Details
Account Holders Name *
Bank Account Number *
Bank Sort Code * - -
Please confirm you are the account holder and you are the only person required to authorise direct debits from this account. However if you're not the account holder please do not tick the box and click Next and you will be given the option to print a Paper DDI. *

Customer Name
Date of Birth 01/01/1970
Address
Telephone
Mobile Phone
E-mail
Promo Code
beeZ Card Number
Bank Account Name
Bank Account Number
Bank Sort Code --
Chosen Plan
Minimum Term Month (Non Cancellable in this period)

First Direct Debit on 01/01/1970
First Full Payment £0.00
First Direct Debit Total £0.00

The name that will appear on your bank statement will be Blackburn with Darwen Borough Council

Collecting Agent: Debit Finance Collections Plc, PO Box 6046, Milton Keynes MK1 9BA Telephone: 01908 422007

E-mail: [email protected] (All enquiries concerning payments should be made to this address)

Company Registration No. 3422873




Direct Debit Instruction

Debit Finance Blackburn with Darwen Borough Council
Culture Leisure Sport and Young People
Blackburn Central Library, 3rd Floor
Town Hall Street
Blackburn
Lancashire BB2 1AG


Direct Debit
Instruction to your
Bank or Building Society
to pay by Direct Debit
Name(s) of Account Holders(s)
Bank/Building Society account number
Branch Sort Code
--
Name and full address of your Bank or Building Society
To The Manager       Bank/Building Society


Address
Postcode
Service User Number
972439
Reference
8773
Instruction to your Bank or Building Society
Please pay Blackburn with Darwen Borough Council Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with Blackburn with Darwen Borough Council and, if so, details will be passed electronically to my Bank/Building Society.


Date


23/06/2017
Banks and Building Societies may not accept Direct Debit Instructions for some types of account

Direct Debit

The Direct Debit Guarantee


  • This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.

  • If there are any changes to the amount, date or frequency of your Direct Debit, Blackburn with Darwen Borough Council will notify you 5 working days in advance of your account being debited or as otherwise agreed. If you request Blackburn with Darwen Borough Council to collect a payment, confirmation of the amount and date will be given to you at the time of the request.

  • If an error is made in the payment of your Direct Debit, by Blackburn with Darwen Borough Council or your bank or building society you are entitled to a full and immediate refund of the amount paid from your bank or building society.

    - If you receive a refund you are not entitled to, you must pay it back when Blackburn with Darwen Borough Council asks you to.

  • You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.


Please Print Off and retain for your records.

Please read the Terms and Conditions

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I have read the terms and conditions above and agree to them. *



Please click Next only once, it may take up to one minute for confirmation of your Payment to appear.