Personal Details Would you like to set up a new direct debit or change an exsisting one(required) This is a new Direct Debit Please change my existing Direct Debit details Please use this form to set up a new direct debit instruction or tell us if you have changed your bank or bank account details. Customer Name(required) Customer Account Number (as it appears on your water bill)(required)If you are a new customer and you are setting up a new account enter 'New' Your account number will appear as 6 digits then a dash and then a single digit Daytime Telephone Number(required) (in case we need to contact you) Email Address(required) This is the email address where we will send your water bill and other bill related correspondence Paperless Billing I wish to receive my bills by email Select payment frequency(required)Choose to spread your water bills over 12 equal monthly payments or pay one quarterly payment which is collected in full on your desired payment date. Monthly Quarterly Number of Permanent Occupants (adults and children)(required)Please enter the number of occupants (this is needed in order to accurately set up your payments) Select Desired Payment Date(required) 4th 11th 20th 28th (Please tick appropriate box) Instruction to pay your Bank or Building Society Name(s) of Account Holder(s)(required) (as it appears on your bank statement) Originator's Identification Number Bank/Building Society Account No:(required) Bank account number is 8 digits Name of your Bank or Building Society(required) Branch Sort Code(required) Insert a dash between digits (ie: 12-34-56) Is the account in your name? (required) Yes No Are you the only signatory required to authorise this Direct Debit(required)If your bank account requires more than one person to authorise debits on the account you will need to complete the Ways to Pay form (see link below) and post it to us with the required authorised signatures. If you can sign cheques or have your own debit card on this account then you are authorised and can complete this instruction online. Yes No If your bank account requires more than one signature to access funds please download and send us a completed paper Direct Debit PDF form with the authorised signatures. Please pay Jersey Water from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with Jersey Water and, if so, details will be passed electronically to my Bank/Building Society. The Direct Debit Guarantee • 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, Jersey Water will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request Jersey Water 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 Jersey Water 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 Jersey Water asks you to • This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits • 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. Type the characters below(required) This field should be left blank Submit your Direct Debit Application Please wait...