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