Electronic Direct Debit Request Form

This secure website allows customers to sign up to pay by direct debit over the internet. If a business has referred you to this site, please complete the following fields with the codes you have been given. You will then be transferred to the business's secure direct debit sign-up page, ensuring your direct debit payments are applied to the correct business.

Only pre-approved businesses are provided the functionability to sign customers to Ezidebit Direct Debit electronically.