Direct Debit Instruction

Your Details

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Name on Account *

Bank Name *

Sort Code (no hyphen or spaces) *

Account Number *

Address where account is registered *

Declaration

Please pay Go Cardless (working on behalf of The Worthing Page) 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 GoCardless and, if so details will be passed electronically to my Bank/Building Society I have read and understand The Worthing Page's T&Cs, specifically relating to cancelled Direct Debits *

Yes

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Date *

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Direct Debit Instruction

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