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, 478 KB].

Please note: Online Direct Debit Authorities can only be accepted for single-signer accounts. To set up a Direct Debit from an account requiring more than one signature, please download the form [PDF, 478 KB], fill it in, and return it to us.

Direct Debit Authority

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:
(00-0000-0000000-000) 
 
Bank:
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.

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

We will send you details of this authority within the next 5 business days.
If you wish to cancel this direct debit authority please contact us on (03) 347-2800.

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