P O Box 27
Please fill in the whole form using a ball point pen and
send it to the above address.
Name and Address
Name(s) of Account Holder(s)
Bank/Building Society account number
Branch Sort Code
Name and full postal address of your Bank or Building Society
To: The Manager
Business Rates Account Number:
Instruction to your
Bank or Building Society
To pay by Direct Debit
Originator's Identification Number
8 5 8 9 0
PLEASE TICK APPROPRIATE BOX FOR
PAYMENT DATE REQUIRED
of month 9
of month 25
Instruction to your Bank or Building
Please pay Cherwell District 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 Cherwell District
Council and if so may be passed electronically to
my bank / building society.
For official use only:
Banks and Building Societies may not accept Direct Debit Instructions for Some types of account
This guarantee should be detached and retained by the Payer
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
If the amounts to be paid or the payment dates change Cherwell District Council will notify you10 working
days in advance of your account being debited or as otherwise agreed.
If an error is made by Cherwell District 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 us.