P 0
Box
27
Banbury
Oxon
OX15 4BH
Cherwell
~,,..-------
./
DtSTRI
CT
COUN
CIL
NORT
H
OXFORD
SHIRE
Please fill in the whole
fo
rm,
including official use box,
using a ball point pen and send it to the above addres
s.
.
~~
~~~~~~~~~~~~~~~~~
~~~---.
Name(s)
of
Account Holder(s)
Bank/Building Society account number
Branch Sort Code
Name and full postal
ad
dress
of
your
Bank
or
Building
Society
To
: The Manager
Address:
Postcode:
Council T
ax
Account Numbe
r:
DIRECT
Debit
I
nstruction
to
your
Bank
or
Building
Society
To
pay
by
Direct
Debit
Originator's Identification Number
4
8 5 8
9 0
Please tick preferred payment date:
D1
51
of
Month D
gth
of
Month
D
18
1
h
of
Month D 25
1
h
of
Month
Spread
in
stalments to March D
Or
statutory instalments (until January) D
lnstructfon
to
your
Bank
or
Building
Soci
ety
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 Counc
il
and if
so
may
be pass
ed
electronically to
my
bank I building
society.
Signature(s)
Date:
Daytime Telephone Number:
Banks and Building Societies may not accept Direct Debit Instructions for some types of account
lmi!'l
....
____
,,
__
_
This guarantee should be detached and retained by lhe Payer
The
DIRECT
Direct
Debit
Debit
Guarantee
This
Gu
arantee
is
offered by all banks and building societies that
acc
ept instructions to pay Direct Debits.
If
ther
e
are
a
ny
changes
to
the
amount, date
or
fr
equency
of
your
Dir
ec
t
Deb
it Cherwell District Council will
notify you 10 working
days
in advance
of
your
account
bGing debited
or
as
otherwise
agr
eed.
If
you request
Cherwell District Council to collect a payment. confirmation
of
the
amount
and
date will be glvcm
to
you
at
the
time
of
the request.
If
an
er
ror
is
made in the
pay
ment
of
yo
ur Direct Debit by Cherwell Dis
tr
ict
Cou
nc
il
or
your
bank or building
society you are entitled to a full and immediate refund of the amount paid from
your
bank or building society.
If
you r
ece
ive a refund you are
not
entitled to, you
must
pay
it back when
Cherw
ell District Council asks you to.
You can cancel a Direct Debit
at
any
time
by simply contacting
your
ba
nk
or
building society. Written
confirmation ma be re uired. Please also
notif
us
.
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DO
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