Customer Ref:


Take certain number of debits
Number of Debits:

Payment Information

Payment Day:
First Payment Date:
01 September 2020
I wish to pay a regular Direct Debit of:

Personal Details


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

Eazy Collect Re Hourglass Fitness, Ladywell Annexe, Ladywell, Dover, CT16 1DG

Service User Number:


Checking the box indicates that I am the Bank/Building Society holder and no authority other than my own is required. If more than one person is required to authorise debits from the account, you are unable to setup a direct debit online.