Customer Details Full name/s* Invalid Input Email* Invalid Input Phone* Invalid Input Property address* Invalid Input Postcode* Invalid Input Assessment number* Invalid Input Date you want the direct debit to commence* ... Invalid Input I/we wish to make payments:* Annually Quarterly (25th each quarter) Monthly (25th each month) Fortnightly Weekly Invalid Input Amount you wish to pay Invalid Input Preferred payment day Monday Tuesday Wednesday Thursday Friday Invalid Input Bank Details Account name* Invalid Input Bank* Invalid Input Branch* Invalid Input Town/City* Invalid Input 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) Please attach confirmation of your bank account number (e.g. deposit slip, bank statement, screen shot from internet banking)* Select Invalid Input Authorisation Code Invalid Input Reference (if you would like a reference on your statement) Invalid Input Authorisation * I/we authorise you until further notice, to debit my/our account with all amounts that Matamata-Piako District Council (‘the initiator’) the registered initiator of the above Authorisation Code, may initiate by Direct Debit. You must tick this box to authorise Council to initiate your direct debit * I/We acknowledge and accept that the bank accepts this authority on these Terms and Conditions. You must agree to the terms and conditions Please also read our privacy policy before sending your enquiry. Confirming you are a real person:* Invalid Input Submit
