Registration

Unit 27 Red Lion Business Park, Red Lion Road, Surbiton, Surrey, KT6 7QD
UK Registered Charity Number 1149693
Company Number 08253779, Registered in England and Wales

General Enquiries: [email protected] Direct Debit enquiries: [email protected]

T: 0208 417 0082

Customer Ref:

Schedule

Service/Schedule:

Termination:

Until further notice

Payment Information

Payment Day:

2024

First Payment Date:

15 May 2024

I wish to pay a regular Direct Debit of:

£5.00

Personal Details

Company name

Title

First name

Surname

Date of birth

Line1

Line2

Line3

Line4

Post code

Home phone number

Mobile phone number

Work phone number

Additional Information

Additional Reference:


How did you hear about us?: *
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Instruction to your Bank or Building Society to pay by Direct Debit

Humanity First, Unit 27 Red Lion Business Park, Red Lion Road, Surbiton, Surrey, KT6 7QD

Service User Number:

Custom Bank Reference:

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.

If paying by direct debit, please note that Humanity First has appointed the BACS Approved Direct Debit Bureau, Eazy Collect Services Limited (http://www.eazycollect.co.uk), to collect your payments. Humanity First will be shown on your bank statement for these direct debit payments.