Arthritis Care Direct Debit

SSL Certificates

Title:

Forename:

Middle Name:

Surname:

Date of Birth:

dd: mm: yyyy:

Flat No:

House/Building number or name:

Postcode:

Country:

United Kingdom

Home phone number:

Mobile phone number:

Email address:

Confirm Email address:

Arthritis Care

18 Stephenson Way, London, NW1 2HD

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	Bank/Building Society
Address

	Postcode

Instruction to your Bank or Building Society to pay by Direct Debit

Service User Number

Reference

Instruction to your Bank or Building Society

Please pay Arthritis Care 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 Arthritis Care and, if so, details will be passed electronically to my Bank/Building Society.

Banks and Building Societies may not accept Direct Debit Instructions for some types of account

The Direct Debit Guarantee

This 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, Arthritis Care will notify you 10 working days in advance of your account being debited or as otherwise agreed.
If an error is made by Arthritis Care 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.

Payment Details
Amount:
Other (£2 Min):	£
Frequency:	*
Start date:	*

Your Name

Your Address

Your contact details

Direct Debit Mandate

Instruction to your Bank or Building Society to pay by Direct Debit

Payment Details