AUTHORITY TO ACCEPT DIRECT DEBITS (Not to operate as an assignment or an agreement)
AUTHORISATION CODE: 3144066
TRADING NAME*
TRADING ADDRESS*
EMAIL FOR INVOICES & STATEMENTS*
NAME OF ACTING ACCEPTOR*
I confirm that I am an authority to submit and action the automated payments via direct debit for our business/company.
NAME OF ACCOUNT TO BE DEBITED*
NAME OF BANK*
BANK ACCOUNT (xx-xxxx-xxxxxxx-xxx)*
PAYER PARTICULARS
PAYER CODE
PAYER REFERENCE
I/We authorise you until further notice in writing to debit my/our account with you with all amounts which TONIQ LTD the registered initiator of the Authorisation Code "3144066" may initiate by Direct Debit.
I/We acknowledge and accept that the Bank accepts this authority only upon the conditions listed here.