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Direct Debit Form
Application & additional information for new client application

Please complete the direct debit form as part of the new Customer Application process, or if you are an existing customer and you would like to pay by direct debit.

Please note: you must complete this form to provide authority for Dickie direct to set up a Direct Debit on your behalf.

Direct Debit

Company Details

Enter Email
Confirm Email

Bank account details

For more than 2 signatories, please complete this form and upload it (note: signatories need to be pen-signed):

Download Form

Maximum file size: 100MB

Please provide 15 digital account number
0233339

Conditions of this authority to accept direct debits

  1. I agree that the Initiator must give me at least 10 days’ prior notice of each direct debit, including the first direct debit in a series.
  2. Changes to the amounts or dates of a series of direct debits require 3 days’ prior notice to me.
  3. I can also agree with the Initiator to receive a same day notice for direct debits specifically requested by me.
  4. All notices must be in writing, but can be delivered electronically, if I have agreed that with the Initiator.
  5. I can also ask you to reverse a direct debit up to 120 days after the direct debit if:
    • I didn’t receive proper notice of the amount and date of the direct debit, or
    • I received notice but the amount or date of the direct debit is different from the amount or date on the notice.
  6. If I dishonour a direct debit but the Initiator retries it within 5 business days of the original direct debit, I understand that the Initiator doesn’t need to notify me again about that direct debit.

Authorisation

By submitting this form I/we authorise you, until further notice, to debit funds from my/our account at the financial institution named above and acknowledge that the bank accepts this authority on the conditions listed on the bottom of this form.

Contact Details

For all purchase enquiries send us a message or contact the head office.

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Hastings Railway Rd Store
Hastings Orchard Rd Store
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