Direct Debit Setup Request - Special Arrangement

Please complete the form below with as much information as you can provide so that we can process your application.

Your request will be processed in the following 5 working days. You will receive confirmation in the post the Direct Debit has been set up.

Thank You

Your Name
Title*
Forename*
Surname*
Date of Birth
DD slash MM slash YYYY

We use this for identification & verification purposes as this data is unique to you and provides an extra layer of security to your account. It may also be used for tracing & collection purposes if payments are not maintained.
Other Information
Customer Account Number

Can be found on your latest bill
Account Holders Name*
Account Address*
Contact Number*
Your contact number, preferably your mobile number, helps us to reach you about your water supply, our service to you or responding to your enquiries, when necessary.
Email Address*
Enter Email Confirm Email

You will use this email to login to your online account & we will use this to send notifications of your bill. It also helps us to reach you about your water supply, our services to you or responding to your enquiries, when necessary
Send a Confirmation?
- Yes
Monthly Payment Offer
Please select the amount you would like to pay each month. One of the team may contact you to discuss your payment offer if the amount you propose to pay will not repay your bill in a reasonable timeframe.
Monthly Payment*
Set up a direct debit
This form must be completed by the bank account holder
Bank Account Name*
Sort code*

Please enter in the format xx-xx-xx
Account Number*

Your 8 digit account number. If your account number only has 7 digits please add a 0 at the beginning
Payment Frequency*
Direct Debit payments for customers charged on an unmeasured basis are taken over 8 monthly instalments.

Direct Debit payments for customers charged on a measured basis are taken over 12 monthly instalments.
Which date would you like your payment to be debited?*
Direct Debit Guarantee
If there are any changes to the amount, date or frequency of your Direct Debit, Portsmouth Water Limited will notify you seven working days in advance of your account being debited or as otherwise agreed. If you request Portsmouth Water Limited 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 Portsmouth Water Limited 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 with Portsmouth Water Limited 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.
Privacy Notice
We do retain personal data that you provide to us. For more information on how we process your data and for details on how to opt out of non-essential messages, please see our Privacy Notice
Phone
This field is for validation purposes and should be left unchanged.

Direct Debit Setup Request – Special Arrangement

Please complete the form below with as much information as you can provide so that we can process your application.

Your request will be processed in the following 5 working days. You will receive confirmation in the post the Direct Debit has been set up.

Your Name

Other Information

Monthly Payment Offer

Set up a direct debit

Direct Debit Guarantee

Privacy Notice