Contact Information
Contact Name:
Company Name:
E-mail:
Tel No:
Type of Business:
Legal Entity:
Which Direct Debit Service?
Facilities Management
Contingency Service
Bureau Service – File Submissions only
Bureau Service – Fully Managed Service
Other Services
What Form of Direct Debit do you wish to be set-up for?
Paper Direct Debit
Paperless Direct Debit – Internet
Paperless Direct Debit - Telephone
Paper & Paperless Direct Debit
Estimated Monthly Transaction Volume
Do you already collect by means of the Direct Debit Scheme?
YES NO
How many new customer records do you hope to set up in your first year?
How often do you wish to collect payments?
Daily Weekly Monthly Yearly
Number of total debits per submission?
Average value of individual debits?
How did you hear about RSM2000 Ltd?
From Existing RSM2000 Ltd Customer Bank Recommendation Search Engine Website
Additional comments
I wish to receive future information regarding RSM2000 Ltd’s products and services.