Instruction to your Bank or Building Society to pay by Direct Debit

Direct Debit Logo

Guildford Dental Centre
26, Farnham Road
Farnham Road


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Name of account holder(s):

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Account number
(Bank/Building Society)
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NOTE: Your account number and sort code will identify your bank and branch address.

Instructions to your Bank or Building Society to pay by Direct Debit.

Please pay Guildford Health Ltd Direct Debits 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 Guildford Health Ltd and details will be passed electronically to my Bank/Building Society.

NOTE: Banks and Building Societies may not accept Direct Debit Instructions for some types of accounts.

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 Guildford Health Ltd will notify you at least 10 working days in advance of your account being debited or as otherwise agreed. If you request Guildford Health Ltd 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 Guildford Health Ltd 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 Guildford Health Ltd ask 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.

However if you are not the account holder or if two signatures are required please click here to print a Paper Direct Debit Instruction.

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