Customer Ref:
Schedule
Service/Schedule:
Single - 41 week DD Schedule - Fixed
Termination:
Take certain number of debits
Number of Debits:
10
Payment Information
Payment Day:
20
August
2024
First Payment Date:
20 August 2024
The first amount (if different to the regular amount) should be:
£
601.01
Total First Payment:
£
I wish to pay a regular Direct Debit of:
£601.02
Personal Details
Title
---Select---
Mrs
Mr
Miss
Ms
Dr
Sir
Lord
Lady
Prof.
Rev.
Master
Mx
---Other---
First name
Surname
*
Line1
Line2
Line3
Line4
Post code
Home phone number
Mobile phone number
Work phone number
Email
*
Instruction to your Bank or Building Society to pay by Direct Debit
APS Re UHI, University of the Highlands & Islands, U H I House, Old Perth Road, Raigmore, Inverness, IV2 3JH
Service User Number:
Account holder name
Account number
Bank sort code
Please tick to confirm you are the only person required to sign for this account
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.