Regular Payment Form

Set up a new standing order

* Must be completed in order for your request to be processed

Customer Account Details
Account Name
Short Code
Account Number

Beneficary Details- who you to pay

Short code
- -
Account Number
Beneficary Name
Reference

Please complete relevent section below and then sign and date the form

Payment Details
Amount of first payment
Amount of usual payment
Frequency Paymnt
(Weekly/Monthly/Annualy)
Date of First payment
/ /
Date of last payment
/ /
Day of usual payment
Or Please continue until further notice  
Customer signature
Customer Tel. No.
Date
/ /

Where singning mandate dicates both all to sign all parties must authorize instruction

Please return the completed form to Your Banker