Direct Debit On-line Form

Contact details

Title

First Name *

Last Name *

Address 1 *

Address 2

Address 3

Postcode *

Telephone *

Email *

Membership Number

Authorisation

Please confirm that the following details you entered are correct

Name: {name-1-prefix} {name-2} {name-3}

Address:
{address-1-street_address}
{address-1-address_line}
{address-1-city}
{address-1-zip}

Telephone: {phone-2}

Email: {email-1}

Membership Number: {number-1}

Bank Account Details

Account Holder(s): {text-1}

Branch Sort Code: {text-3} Account Number: {text-4}

Amount: {select-1}

{checkbox-2}

I would like MHDS to collect my annual subscription (£15), plus any other subscriptions due from Joint or Junior members (£10) living at my address, from 22nd August 2022 by direct debit. Fees quoted above are applicable to the year ending August 2022 and may be adjusted for the following year in line with decisions agreed at the MHDS Annual General Meeting. Please note Direct Debit payments to MHDS appear as ‘charity donations’ on bank statements.

I confirm that I hold a personal account with a bank or building society and that I am the sole required signatory on the account.Please tick to confirm that you wish to set up an online Direct Debit. If you are not the sole required signatory, please contact us in order to complete a paper mandate.

The Direct Debit Guarantee
Service User Number 277937

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, CTT Charity Payments will notify you 10 working days in advance of your account being debited, or as otherwise agreed. If you request CTT Charity Payments 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 CTT Charity Payments 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 CTT Charity Payments 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 us.