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Customer Details

Full name/s*
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Email*
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Phone*
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Property address*
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Postcode*
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Assessment number*
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Date you want the direct debit to commence*
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I/we wish to make payments:*

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Preferred payment day
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Amount you wish to pay
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Bank Details

Bank*
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Branch*
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Town/City*
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Bank account number for payments to be made from*
Enter your bank code (2 digits)
Enter your branch code (4 digits)
Enter your account number (7 digits)
Enter your account suffix (max 3 digits)
Follow the format 12 - 1234 - 1234567 - 00. You do not need to enter dashes or spaces.
Please attach confirmation of your bank account number (e.g. deposit slip, bank statement, screen shot from internet banking)
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Authorisation Code
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Reference (if you would like a reference on your statement)
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Authorisation

You must tick this box to authorise Council to initiate your direct debit
You must agree to the terms and conditions
Please tick the box:*
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Please also read our privacy policy before sending your enquiry.