Direct Debit Form

Direct Debits automatically pay all of your bill when it's due. It gives you the peace of mind knowing your bill will be paid on time, it's all sorted.

If you have an existing Direct Debit and would like to change the Bank Account it comes from, you will need to follow this process as well.

To setup a Direct Debit online, you agree to our Conditions of Authority to Accept Direct Debits and be the only signatory on the bank account.

If there is more than one signatory on your bank account you must use the PDF paper version and obtain all the signatures of the account holders.

Should you wish to query, amend or cancel these instructions please contact us.

Merchant Details

Merchant ID *

Trading name *

Contact name *

Phone number *

Email *

Account Details

Name of Account *

Bank Account *

Bank Name *

Branch *

Statement Details

Payer Particulars *

Payer Code *

Payer Reference *

Confirmation

Sole signing - I have sole signing authority on this bank account *

Direct Debit - I have read and accept the Conditions of Authority to Accept Direct Debits *

By submitting this form, I confirm that I have read and understand the terms of use from Paymark, and that Paymark will process my personal data as stated in the privacy notice.