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Water Billing EasyPay Form

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Use this form to provide authority to Selwyn District Council to create a Direct Debit on your bank account to pay your Water Bill. All fields (except mobile number and email) are required. Alternatively, download a PDF copy of the form [PDF, 195 KB].

I/We acknowledge and accept that the bank accepts this authority only upon the conditions of this authority. I/We wish to make my payment by Direct Debit.

Property & Contact Details
Water Billing Customer Number:
Contact Name:
Daytime Phone:
Home Phone:
Mobile Phone:
Email:
Bank Account Details
Name (of bank account holder)
Account Number:
Bank:
Branch:
Address: (PO Box)
Town/City:
Authorisation

This form authorises Selwyn District Council until further notice to debit my/our account with all amounts which Selwyn District Council (the registered Initiator of Authorisation Code 0304862) may initiate by Direct Debit.

I/We acknowledge and accept that the bank accepts this authority only upon the conditions listed here, and acknowledge that I have read and accept the conditions, am the owner of the property above, and am authorised to create this Direct Debit Authority.

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