Please complete the forms below to authorise your Direct Debit.

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.)

First name*      * denotes a required field.
Address 1*  
Address 2  
Address 3  
County / Area  
Telephone number* UK Telephone Land Line Only (No Spaces)
Mobile number UK Mobile Number Only

* Required Fields
Direct Debit Logo

Instruction to your Bank or Building Society to pay by Direct Debit

EH16 6AE 0131 357 3453
Service user number:
Your Membership Number:
* Name of account holder(s)
* Sort code
* Account number
NOTE: Your account number and sort code will identify your bank and branch address.
Instructions to your Bank or Building Society to pay by Direct Debit.

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

NOTE: Banks and Building Societies may not accept Direct Debit Instructions for some types of accounts.

24 Jun 2024

  • 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 BrightCare will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request BrightCare 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 BrightCare 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 BrightCare 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.

*Check Authorisation
Please check this box to confirm that you are authorised to submit this Direct Debit agreement.

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