Direct Debit Request

Direct Debit Request

Preliminary Information
Thank you for you interest in setting up a direct debit. Direct debit is the most efficient and cost effect means of payment.

This information will be used to set up the direct debit request. A subsequent email will be sent to your from our payment processor (Rotessa or Plooto) to provide your banking information and authorization. If you do not receive the email in the next couple of days, please first check your SPAM/junk file folder. If it is not there then please contact our office to investigate.

Thank you.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Who do you want to pay via a recurring direct debit:*
What do you want to pay via a recurring direct debit:*

DonationsRentTuitionsOther
How much do you want the direct debit to be for:*
Rent/Tuition: What date do you want the direct debit to be deducted:

1st of the month (only option)
Donations/Other: How often do you want the direct debit to be deducted:

Semi Monthly 15th and last day of the monthMonthly on the 15thMonthly on the last day of the month
Starting: (Please allow at least 10 days for first payment)*

YearMonthDay
Date
Any other instructions:
Please watch for the set up of the preauthorized debit email from Rotessa or Plooto. Please watch your spam folder. This subsequent email will request your banking information.
Should be Empty: