Please fill in the form below using black ink and return to: Wandsworth Council,
Council Tax Service, PO Box 65962, London SW18 9HN
The Direct Debit Guarantee
Application to pay a summons by Direct Debit
The guarantee is offered by all Banks and Building Societies
that take part in the Direct Debit scheme. The efficiency and
security of the scheme is monitored and protected by your own
Bank or Building Society.
If the amounts to be paid or the payment dates change
Wandsworth Council will notify you 10 working days in advance
of your account being debited or as otherwise agreed.
If an error is made by Wandsworth Council or your Bank
or Building Society, you are guaranteed a full and immediate
refund from your branch of the amount paid.
You can cancel a Direct Debit at any time by writing to your
Bank or Building Society. Please also send a copy of your
letter to Wandsworth Council.
Print name
Date
Banks and Building Societies may not accept Direct Debit instructions for some types of accounts.
Instruction to your Bank or Building Society to pay by Direct Debit
Name(s) of Account Holder(s)
Bank/Building Society account number
Branch Sort Code
Council Tax Account Reference number
To your Bank or Building Society
Please pay Wandsworth Council Direct Debits from the Account detailed in this instruction subject to the safeguards
assured by the Direct Debit Guarantee.
I understand that this instruction may remain with Wandsworth Council and, if so, details will be passed electronically
to my Bank/Building Society.
I
propose to pay the total due on the summons and the additional costs of £28.00, by three consecutive monthly instalments as
detailed below and have provided proof of my income.
1st payment (to be received prior to the court date) is £ on
2nd payment £ on
3rd payment £ on
Print name Date
Council Tax Account Reference number:
Name:
Property address:
D
aytime phone number:
Evening phone number:
Please note direct debit payments can only be collected on the 2nd of the month.
Please complete the section below if you wish to pay by Direct Debit
6 2 4 6 1 9
BT.1320 (2.16)
