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Set up a Direct Debit

Fill in the form below, and we'll call you within the next five working days to set up your Direct Debit with you in just a few minutes.

You'll just need your bank name, sort code and account number. We'll send you a letter to confirm you're set up, as well as the date and amount of future payments.

Contact me to set up a Direct Debit

First name *

Surname *

Email address *

Confirm Email address *

Phone number you wish to be contacted on *

Address line 1

Address line 2

Address line 3

Postcode *

Your A2Dominion account reference number

When would you prefer to receive a call?

	Monday	Tuesday	Wednesday	Thursday	Friday
Morning	Morning - Monday	Morning - Tuesday	Morning - Wednesday	Morning - Thursday	Morning - Friday
Afternoon	Afternoon - Monday	Afternoon - Tuesday	Afternoon - Wednesday	Afternoon - Thursday	Afternoon - Friday

Preferred payment frequency

Please note that all Direct Debits are made in advance.

Click submit and we'll get in touch with you to help set up your Direct Debit within five working days.

For information on how we use your personal data, go to www.a2dominion.co.uk/privacy