Registration for BACS Direct Credit

Supplier Reference: (Alpha/Numeric reference as quoted on the mailshot)

VAT Number (or NA if non-VAT registered):

Name of Bank/Building Society:

Branch Address:

Sort Code (6 digits):

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Account Number (8 digits):

E-mail Address: (for sending electronic remittance advice)

Fax Number: (for sending electronic remittance advice)

Contact Name: