Direct Debit Form

Latest revision date: August 2020
Revision due date: August 2021


Before you begin


Who is this form for?

Please complete this form if you wish to sign up to direct debit payments for your rent.

Protecting your personal data

By completing this form you acknowledge that we will follow our responsibilities under data protection legislation.

Berneslai Homes has a contract in place with Allpay Ltd to provide our customers with a safe, flexible direct debit payment option for making rent payments. We collect your bank account details so we can send these along with details of your payment plan to Allpay Ltd. We do not keep details of your bank account on our system. Your payments are protected under the Direct Debit Guarantee and are identified on your bank statements as a payment made to Berneslai Homes.

For more information about the way we protect your personal data, please see our privacy policy on our website
  • About you
  • Title *

  • First Name *

  • Last Name *

  • Phone number

  • Your address

  • Berneslai Homes Rent Reference

  • Your bank and direct debit details
  • How often do you want to pay your rent?

  • Which day of the week do you want to pay?

  • Which day of the week do you want to pay?

  • What day of the month do you want to pay?

  • When do you want the Direct Debit to start? Please note we cannot set up a direct debit until at least 5 working days after your request. *

  • Name(s) of account holder(s):

  • Bank/Building Society Account number:

  • Branch sort code:

  • Name and full postal address of your Bank/Building Society:

  • Confirmation
  • - I confirm that I wish to pay Allpay Ltd Direct Debits from the account detailed in this form.

    - I understand that the information given on this form will be shared with Allpay Limited and, if so, details will be passed electronically to my Bank or Building Society.

    - I declare that the information I have given on this form is correct and complete.

    - I understand that if I have not completed this form fully it may result in a delay in us acting on your request.