Direct Debit Form

Membership Details - Step 1

Staff Number

Date Joined NCA - (dd/mm/yyyy)

Title

First Name

Last Name

Postcode

Telephone

Email

Direct Debit - Step 2

Subscription

StartDate

Message advising member not to cancel Payroll deduction until written DD notification of payment

Bank Details - Step 3

You have chosen to set up a Variable Direct Debit. Subject to your rights under The Direct Debit Guarantee, this will automatically debit payments due on your account from your bank or building society account. If you are a joint signatory on the account, a paper direct debit instruction will be sent to you in the post/can be downloaded for completion.

Account Holder Name

Account Number

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 account holder and no authority other than my own is required. If more than one person is required to authorise Debits from the account, leave this box unchecked and we will send you a paper Direct Debit Instruction for completion.

I understand and agree to the Terms and Conditions.

I have read and accept the privacy policy

Confirm Details - Step 4

Service User Number: 442346

Confirm Account Details

Please confirm whether the details above are correct. If not, please go back and correct these details. If they are correct please click on confirm.

The Direct Debit Guarantee

This 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 Eazy Collect Re NCOA will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request Eazy Collect Re NCOA 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 Eazy Collect Re NCOA 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 it back when Eazy Collect Re NCOA 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.

Please correct the following errors;