Direct Debit Form

Student Details

Please enter the details of your youngest child if you have more than one attending MMTQ.

Name *

Gender *

Class *

Class *

Please write the names of any other children that attend MMTQ

Details of the person who will be making the payments

Name (As shown on bank) *

Email *

Phone *

Billing Address *

Relationship to child *

If other: *

Payment Details

Bank Name *

If other *

Sort Code *

Enter Numbers only, no dashes

Account Number *

The Direct Debit Guarantee

Please read the declaration below fully before signing:

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 MMTQ will notify you 5 working days in advance of your account being debited or as otherwise agreed.
If you request MMTQ 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 MMTQ 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 MMTQ 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 by emailing info@mmtq.org.
This mandate must only be signed by the parent or guardian of the above.

Signature