Direct Debit Form

Please fill in our direct debit form.

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Layout

Name(s) of Account Holder(s)

Bank or Building Society account number

Branch Sort Code

Name and full postal address of your Bank or Building Society

To The Manager Bank/Building Society:

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Dear Customer: Please Complete Below for Our Records

Name

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Email

Phone

Instruction to your Bank or Building Society

Please pay FastPay Ltd Re Toffoo Limited t/a XL Telecom Direct Debits from the account detailed in this instruction subject to the safeguards assured by the Direct Debit Guarantee.

I understand that this instruction may remain with FastPay Ltd Re Toffoo Limited t/a XL Telecom and, if so, details will be passed electronically to my Bank/Building Society.

Signature

Date / Time