Burnley Borough Council

Council Tax Direct Debit Application Form
To setup a Direct Debit for Council Tax please complete the form below.
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this form.
If you are not the only required signatory on your account, or you would rather send us a paper version of this form, click here (PDF file - you will need a copy of Adobe's Acrobat software to read this file - you can download this software for free.)

Account Holders Name(s)



Bank /Building Society Account Number



Branch Sort Code



Sortcode
Bank /Building Society Name
Address
Town
County
Postcode

Council Tax Reference Number



Your Name



Your Address



Address line 1
Address line 2
Town
County
Postcode

Your Telephone Number



Preferred Council Tax Payment Date









Payment Period





Instruction to your Bank/Building Society

Please pay Burnley Borough Council Direct Debits from the
account details in this instruction subject to the safeguards
assured by the Direct Debit Guarantee. I understand that this
instruction may remain with Burnley Borough Council and if so,
details will be passed electronically to my Bank/ Building Society.


The Direct Debit Guarantee

 Direct Debit Logo
  • 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 Burnley Council will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request Burnley Council to collect a payment, confirmation of the amount and date will be given to you at the time of the request.
  • If you request Burnley Council 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 Burnley Council 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 Burnley Council 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.

Thank you for completing you Council Tax mandate.
Please press submit to send the details to us. You will receive
confirmation of your direct debit instruction by post within
3 working days. Please contact us if the details are incorrect.
A revised Council Tax bill will also be sent to you.