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Direct Debit Online Form

Citizens Advice Flintshire, Terrig House, Chester St, Mold, CH7 1EG

Instruction to your Bank or Building Society to pay Citizens Advice Flintshire Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with Citizens Advice Flintshire and, if so, details will be passed electronically to my bank/building society.

Amount

 £5 £10 £20 Other
£

Date of payment each month
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Your full name

Your full Address

Your email address

Bank/Building Society account number

Branch sort code

Name and full postal address of your Bank/Building Society

Payment reference

I would like to Gift aid my monthly donation

 I confirm that I am a UK taxpayer. I understand that if I pay less Income and/or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all my donations, it is my responsibility to pay the difference.

25p Will be added to every £1 you donate to Citizens Advice Flintshire including donations you've made in the last four years.

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Banks and building societies may not accept Direct Debit instructions for some types of accounts

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 Citizens Advice Flintshire will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request Citizens Advice Flintshire 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 Citizens Advice Flintshire 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 Citizens Advice Flintshire 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 Citizens Advice Flintshire, either by post: Terrig house, Chester street, Mold, CH7 1EG or by calling 01352 706840