Direct Debit Form

Direct Debit

Instruction to your bank or building society to pay by Direct Debit

Service User Number: 726059

Please pay Southgate Progressive Synagogue (SPS) direct debits from the account detailed in this instruction subject to safeguards assured by the Direct Debit Guarantee. I understand this instruction may remain with SPS and, if so,details will be passed electronically to my bbank/building society.

Your full name *

Your address (inc. post code) *

Email address

Name(s) of Account Holder(s) *

Bank sort code *

six digit sort code

Bank account number *

Eight digit bank account number

Banks and building societies may not accept direct debit instructions for some types of account.

Name and address of your bank

Reference (to be completed by SPS)

Instruction to your bank or building society

Please re-type your surname to act as an electronic signature *

By entering your surname you are confirming your instruction.

Date

Email address

Confirm email address

Signature:

Please sign your name in this box:

IMPORTANT: Please print this form BEFORE PRESSING 'SUBMIT' to enable you to sign form and scan/send it to us.

Direct Debit Guarantee

The Direct Debit Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.

If there are any changes to the amount, date or frequency of your direct Debit, Southgate Progressive Synagogue (SPS) will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request SPS to collect a payment, confirmation of the amount and date will be given to you at the time of the request.

If an error is made in the payment of your Direct Debit, by SPS or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society. If you receive a refund you are not entitled to, you must pay in back when SPS asks you to.

You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.