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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