Matamata-Piako District Council

Customer Details

Full name/s*

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Email*

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Phone*

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Property address*

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Postcode*

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Assessment number*

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Date you want the direct debit to commence

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Please allow 3 working days for our team to get you all set up.

I/we wish to make payments:*

Preferred payment day

The payment is calculated for you, we will confirm the amount by email once the direct debit is set up.

Bank Details

Account name*

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Bank*

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Branch*

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Town/City*

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Bank account number for payments to be made from*

Enter your bank code (2 digits)

*

Enter your branch code (4 digits)

*

Enter your account number (7 digits)

*

Enter your account suffix (max 3 digits)

Please attach confirmation of your bank account number (e.g. deposit slip, bank statement, screen shot from internet banking)*

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Authorisation Code

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Reference (if you would like a reference on your statement)

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Authorisation

*

I/we authorise you until further notice, to debit my/our account with all amounts that Matamata-Piako District Council (‘the initiator’) the registered initiator of the above Authorisation Code, may initiate by Direct Debit. You must tick this box to authorise Council to initiate your direct debit

*

I/We acknowledge and accept that the bank accepts this authority on these Terms and Conditions. You must agree to the terms and conditions

Please also read our privacy policy before sending your enquiry.

Confirming you are a real person:*

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