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Title *
First Name *
Last Name *
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Address & Contact Details Click Here for More Information
Company Name
(if applicable)
House Name/Number *
Postcode *
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(if not available please repeat first telephone number here)
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Bank Details Click Here for More Information
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
Telford Loyalty 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 T&W 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 T&W Council
Darby House
Lawn Central
Telford
Shropshire TF3 4AJ


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
942703
Reference
8248
Instruction to your Bank or Building Society
Please pay T&W 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 T&W Council and, if so, details will be passed electronically to my Bank/Building Society.


Date


24/05/2017
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, T&W Council will notify you 5 working days in advance of your account being debited or as otherwise agreed. If you request T&W 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 T&W 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 T&W 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.

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