* Required Fields
 
 

Direct debit - Creditor’s details:

 

Creditor name:

 

Ibec

 

Creditor address:

 

84-86 Lower Baggot Street, Dublin 2

 

 

IE83ZZZ306222

 

 

We will advise you of the UMR before the first initiation of a collection

 

Direct Debit Mandate Form details:

 
Debtor's name*
 
 
Debtor address*
 
 
BIC*
 
 
IBAN*
 
 
The bank account is a Republic of Ireland bank account:*
 
Yes
No
 
Can the bank account accept Direct Debit:*
 
Yes
No
 
Is more than one signatory required to sign on your account:*
 
Yes
No
 
Direct debit payment type*
 
 

Explanation of payment type options:

  1. "Once off" - is a single direct payment on January 1st of each year or the 1st of the month from sign up of after January 1st
  2. "Recurring - monthly" on the 1st of each month
  3. "Recurring - quarterly" on the 1st of the following months: January, April, July and October
 
 
 

Your contact details:

 
Salutation*
 
 
First Name*
 
 
Last Name*
 
 
Company name*
 
 
Email address*
 
 
Telephone*
 
 
Ibec customer no. (if applies)
 
 

Ibec Privacy Statement covers the processing of personal data in the course of the performance of Services by Ibec.