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Direct Debit Form

Please fill in the below form if you're a new or existing customer, and wish to pay via Direct Debit.

If you are looking to sign up with Utilita in your new home and we do not already have the supply; please visit our Sign-Up page.

Customer Reference Number

Please enter your customer reference number, it will help us help you quicker.

Customer Reference Number:

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Your Details

Title:

First name:

Last name:

Email:

Home phone:

Mobile phone:

Postcode:

Find my address

Address 1:

Address 2:

City:

County:

Your Comments:

Direct Debit Details

Bank/Building Society

Bank/Building Society Name:

Postal Address:

Postcode:

Account Details

Account Holder(s) Names:

Account Number:

Branch Sort Code:

Instruction to your bank or building society to pay by Direct Debit

Gas Amount:

Electricity Amount:

Date of Month:

Please note that if we cannot start your direct debit on your selected date this month it will be forwarded to next month.

Reference:

Service user number:

Please pay Utilita Energy Ltd. Direct Debits from the account detailed in the Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with Utilita Energy Ltd. and, if so, details will be passed electronically to my bank/building society.

Please check the details you have entered before pressing submit.

Banks and building societies may not accept Direct Debit Instructions for some types of accounts.

The Direct Debit Guarantee

This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.
If there are any changes to the amount, date or frequency of your Direct Debit Utilita Energy Ltd. will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request Utilita Energy Ltd. to collect a payment, confirmation of the amount and date will be given to you at the time of the request.
If an error is made in the payment of your Direct Debit, by Utilita Energy Ltd. or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society.
If you receive a refund you are not entitled to, you must pay it back when Utilita Energy Ltd. asks you to.
You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.

Direct Debit Form

Customer Reference Number

Error, No customer reference number.

Your Details

Direct Debit Details

Bank/Building Society

Account Details

Instruction to your bank or building society to pay by Direct Debit

The Direct Debit Guarantee

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