Greensquare Estates

Direct Debit instruction form

Direct Debit instruction to your bank or building society to pay GreenSquare Estates

Bank account details

Your name *

Your address *

Name of your bank or building society *

Bank/building society account number *

Sort code *

Instruction to your bank or building society to pay by Direct Debit

Service User Number: 840672

Please pay allpay Ltd Re: Greensquare Estates Ltd 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 allpay Ltd Re: Greensquare Estates Ltd and, if so, details will be passed electronically to my bank or building society.

Name (signed) *

Date *

Direct Debit payment details

Customer reference number *

First payment amount *

Date of first payment *

Subsequent payment amount *

Next due date *

Payment frequency * Weekly Fortnightly Monthly Quarterly Annually

Enter details of the customer, if different to the bill payer

I consent to GreenSquare Estates processing my personal information and setting up this Direct Debit instruction. *