Southern Counties Fuels

Direct Debit Application

Instruction to your Bank or Building Society to pay by Direct Debit

Name(s) of Account Holder(s)

Bank/Building Society Account Number

Branch Sort Code

Name and full postal address of your Bank or Building Society

Originator's Identification Number

Reference Number

Instruction to your Bank or Building Society
Please pay Southern Counties Fuels, 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 Southern Counties Fuels and, if so, details will be passed electronically to my Bank/Building Society.

Banks and Building Societies may not accept Direct Debit Instructions for some types of account.

PLEASE POST TO: -

FREEPOST Southern Counties Fuels, Colwood Lane, Warninglid,
Near Haywards Heath, West Sussex, RH17 5ZA