Signup and DD

New Customer Signup Form
Customer Type
Name

First NameLast Name
Company
Invoice Address

Street Address

Street Address Line 2

CityState / Province

PostcodeCountry
Office Phone Number
Mobile Phone Number
Email
example@example.com
Installation Address
Installation Address

Street Address

Street Address Line 2

CityState / Province

PostcodeCountry
Have you been referred by someone? Please enter their name below.
Notes

Instruction to your Bank or Building Society to pay by Direct Debit
Name(s) of Account Holder(s)
Bank/Building Society account number
Branch Sort Code
Instruction to your Bank or Building Society

Please pay Inteleweb Ltd Direct Debits from the account detailed

Name and full postal address of your Bank or Building Society

in this instruction subject to the safeguards assured by the Direct

I understand that this instruction may remain with Inteleweb Ltd and, if so, details will be passed electronically to my Bank/Building Society.
Signature(s)
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
The Direct Debit Garuantee
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, the organisation will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request the organisation 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 the organisation 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 the organisation 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.
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New Customer Signup Form