Direct Debit Form

I/We request Forbes Shire Council (Debit ID No: 126154) to arrange for funds to be debited from my/our nominated account at the financial institution shown below:-
Applicants Details
Amendment to a previous Direct Debit ?* - required
Financial Institution Details
(Payment will be deducted on corresponding Thursday)
On the following basis:
Frequency* - required
For the amount stated on the rates notice issued by Council on the following basis:
RATES:* - required
WATER:* - required
For the total amount due on the Tax Invoice issued by Council for:

Please type your signature

Please sign here

(If debiting from a joint bank account, all signatures are required.)

Please complete if nominating authority to debit above mentioned account for more than one property:

Assessment # 2
Assessment # 3
Mandatory field(s) marked with *