Building Societyto Pay

Instruction to your bank or

building societyto pay

by Direct Debit

What is your Orbit account address? / Or your Orbit account reference?
Please fill in the whole form using a ball point pen and send to: / Originator's Identification Number 977468
Orbit
PO Box 6406
Coventry
CV3 9NB
Or alternatively scan it and send it to:
/ Please complete the details requested in this section
This is not part of the instruction to your bank or building society
Please tick which payment date you want:
Weekly (on a Monday)
 Fortnightly (on a Monday)
 Monthly 1st  Monthly 10th
 Monthly 15th  Monthly 28th
Please note that if you do not pick a payment date we will set your direct debit to be collected monthly on the 1st of the month.
If you select to pay on a monthly basis, and your account is in arrears we will collect these with the first direct debit payment unless you have an agreement. If this causes difficulties, please contact us
Name[s] of account holder[s]:
Bank / building society account number:
Branch sort code:
- / -
Name and full address of your bank or building society:
To the Manager ……………………..
Bank / building society
Address
Postcode: / Instruction to your bank or building society
Please pay Orbit Group Limited 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 Orbit Limited and, if so, details will be passed electronically to my bank/building society.
Print name[s]:
Date: / Signature[s]:(if a joint account both must sign)
X………………………………………………………..
X……………………………………………………….
Which Orbit account do you want set up at Direct Debit (please tick all those that apply)?
Rent Home owner  Orbit Alarm Service (ORU)
Other account – enter the details here ………………………………………….………………………

Banks and building societies may not accept Direct Debit instructions for some types of account