Set up your Direct Debit Please complete the details below to set up your Direct Debit securely. Your information will only be used to process payments in line with the Direct Debit Guarantee. Name(Required) First Name Surname Company NameIf ApplicableAddress(Required) Street Address Address Line 2 City ZIP / Postal Code PhoneEmail(Required) Bank Account DetailsBank Name(Required)Select BankBank of ScotlandBarclaysClydesdale BankCo-operative BankHalifaxHSBCLloyds BankMetro BankMonzoNationwide Building SocietyNatWestRevolutSantanderStarling BankTSBUlster BankVirgin MoneyOther / Not listedBank NameAddress(Required) Street Address Address Line 2 City ZIP / Postal Code Name as it appears on your Account(Required) First Name Surname Account Name(Required)Account Number(Required)Please enter a number from 8 to 8.Sort Code(Required)Please enter a number from 6 to 6.Direct Debit Authorisation(Required) I agree to the Direct Debit terms and confirm I am authorised to use this bank account.By signing this form, I authorize Alex Robson Heating and Gas Ltd ("the Company") to collect payments from my bank account as detailed above under the Direct Debit Guarantee. I confirm that I am entitled to authorise debits from this account. 1. This authorization will remain in effect until I cancel it in writing. 2. I may cancel this authorization at any time by notifying Alex Robson Heating and Gas Ltd. 3. Any changes to the amount, date, or frequency of the Direct Debit will be communicated to me in advance. 4. If an error is made in the payment of this Direct Debit, I am entitled to a full and immediate refund from my bank.Signature(Required)Name(Required) First Last