Direct Debit Amendment

This form is for customers amending an existing Direct Debit with a partnering Organisation.

Before you apply, here are a few things we would like to make you aware off:

Customer Terms and Conditions

Customer Data Security

Website Legal Information

Privacy Policy

All compulsory fields are marked with ‘*’.

CUSTOMER DETAILS

Name *

First

Middle

Last

Bank Account Number *

Bank Account Name *

Email *

AMENDMENT TO BILLING DETAILS

Billing Organisation *

Select Applicable

Customer Account Name *

Details of Amendment *

AUTHORISATION

I hereby authorise the Billing Organisation to debit my account (identified above) in respect of the amounts requested under the terms of the Direct Debit Service, in accordance with the Service Terms and Conditions, until further notice by me, in writing, to Bank of St Helena Ltd. As per the Service Terms and Conditions, I agree to maintain sufficient funds within the nominated account and authorise Bank of St Helena to deduct any relevant charges should my nominated account enter into an Unauthorised Overdraft. *

Signature

If you feel your signature is not legible, you may upload it in the section below. This application cannot be accepted without a signature.

Signature Upload (if required)

Click or drag a file to this area to upload.

Date *

Captcha *

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