Direct Debit Mandate for Rents eform

Address
1. Is direct debit instruction for a:
  
  Flat
  
  House
  
  Garage
2. Please give the address of the tenancy to which this request relates
  1. Postcode
    
    Address
3. Postcode
4. Label
  2. Address
  3. (optional)
  4. (optional)
  5. Town
  7. Give the payment reference number (if known) (optional)
5. Authority
  1. Does the bank account used to create this direct debit belong to:
  2. If you are not a tenant of the property, do you consent to this direct debit being set up from your account to cover payments of rent and any arrears agreed by the tenant and the council?