Direct Debit Form - Bin Rental

To pay for your wheelie bin rental by direct debit (currently the only option) please fill in the form below with your details.

Your Details

Name Email Phone Number

Order Details

Order Number

Your Orders

Order #	Date	Product	Status	Total

Bank Details

Only those who hold sole authority on their bank account will be able to set up the direct debit online. If there are multiple authorities on the account please select paper form option and obtain both signatures.

Tick to request a paper Direct Debit Form. We will email you a PDF for printing out, filling and returning.

Bank Account Name Name of the Authorised Account Signatory Bank Name Branch Name Branch Address Bank Account Number Town/City

Authorisation

I authorise you, until further notice in writing, to debit my account with all amounts which Nelmac LTD (hereinafter referred to as the "initiator") the registered initiator of Authorisation Code 0337019, may initiate by Direct Debit.

I accept the Terms and Conditions

I confirm that I am able to operate, and have sole authority for, the nominated bank account for this paperless Direct Debit instruction

I accept confrimation of the online direct debit to be sent to my nominated email address