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Finance & Legal
Direct Debit / Autopay Mandate
Collect signed authorization to debit a customer's bank account on a recurring schedule — bank details, frequency, and the mandate terms that make it stick.
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What this form looks like
Preview · not interactiveDirect Debit / Autopay Mandate
Collect signed authorization to debit a customer's bank account on a recurring schedule — bank details, frequency, and the mandate terms that make it stick.
Account holder name*
Exactly as it appears on the bank account.
Billing address*
The address your bank has on file for this account.
Bank name*
e.g. First National Bank
Account number / IBAN*
Account number or IBAN
Use your IBAN if your country has one; otherwise your account number.
Routing / sort code (if applicable)
e.g. branch, routing, or sort code
Leave blank if your IBAN already identifies the branch.
Payment frequency*
Select…▾
First collection date*
Pick a date📅
The earliest date we may take the first payment.
Mandate terms*
Mandate terms
Account authority*
Account authority
Signature*
Sign here
Sign with your mouse or finger — this executes the mandate.
Submit