Vasek – The Landlord Insurance specialists

Direct Debit Setup

Policy Number *

Policyholders Name *

Policy Type *

Renewal
New Business

Renewal Date *

Email*

Telephone No.*

Premium Amount*

Deposit Amount

11 Monthly Payments of

Billing Information

This should be the same as the details for your card

Title

First Name

Last Name

Address Line 1

Address Line 2

City

Postcode

Contact Email:

Any further information you would like to provide:

Direct Debit Details

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

Name of Account Holder*
(as is appears on the card)

Please enter name

8 Digit Account Number*

Please enter Account Number

6 Digit Sort Code*

- - Please enter sort code Please enter sort code Please enter sort code

You will receive correspondence in the post from Premium Credit, who will collect your instalments on our behalf.

Your application for credit will be passed to Premium Credit Limited. In assessing your application they will search the public information that a credit reference agency holds about you. The credit reference agency will add details of the search and your application to the records they hold about you whether or not your application proceeds. This and other information may be used to make credit decisions about you and undertake checks for the prevention and detection of money laundering.

Please note that all insurance companies who provide Direct Debit must adhere to these new rules and carry out credit searches. By applying to pay your premium by Direct Debit you consent to the search being made.