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