District Heating System Direct Debit Authorization
Customer Details
Full Name
Address
Customer Account Number
Contact Number
Bank Details
Bank Name
Branch
Sort Code
Account Holder Name
Bank Account Number
Payment Details
Preferred Payment Date
Amount (if fixed)
By signing this form, I authorize the District Heating System provider to debit the above account for heating charges as agreed. This authorization shall remain in effect until revoked in writing.
Signature
Date