Please fill in the whole form using a ball point pen and send it to:
Name(s) of account holder(s)
Bank/building society account number
Service user number
Instruction to your bank or building society Please
pay Hodge 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 Hodge and, if so,
details will be passed electronically to my bank/
building society.
Reference
• This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.
• If there are any changes to the amount, date or frequency of your Direct Debit Hodge will notify you 10 working days in advance
of your account being debited or as otherwise agreed. If you request Hodge to collect a payment, confirmation of the amount and
date will be given to you at the time of the request.
• If an error is made in the payment of your Direct Debit, by Hodge 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 receive a refund you are not entitled to, you must pay it back when Hodge asks you to.
• You can cancel a Direct Debit at any time by simply contacting your bank or building society.
Written confirmation may be required. Please also notify us.
The Direct Debit Guarantee
Instructions to your
bank or building society
to pay by direct debit
Hodge
One Central Square
Cardiff
CF10 1FS
Name and full postal address of your bank or building society
This guarantee should be detached and retained by the Payer
Bank and building societies may not accept Direct Debit Instructions from some types of account
Branch sort code
To: The Manager Bank/building society
Address
Postcode:
Signature(s)
Date
840447
