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DirectDebit
WM ICT
2022-10-21T08:07:44+01:00
DirectDebit
By completing this Direct Debt form you are authorizing UNIFORM-Agri to automatically debit your annual invoice amount from your bank account. To terminate or change the authorization, please contact our administration at info@uniform-agri.com.
Name(s) of the Account Holder(s)
(Required)
Bank/Building Society account number
(Required)
Branch Sort Code
(Required)
Email (for confirmation e-mail)
Name and full postal address of your Bank or Building Society
Bank/Building Society
Address
Postalcode
Date
MM slash DD slash YYYY
Approval
(Required)
I hereby approve that UNIFORM-Agri B.V. can automatically withdraw from my bank account.
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