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https://www.aciuk.co.uk/form-DD
Submission Tags: falconsandbox
Submission: On February 17 via api from US — Scanned from DE
Submission Tags: falconsandbox
Submission: On February 17 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST javascript:void(0);
<form class="form-dd" action="javascript:void(0);" method="post" novalidate="novalidate">
<div class="aci-form1">
<h3>Instruction to your bank or building society to pay by Direct Debit</h3>
<label> ACI Customer Reference <span class="ff-req">*</span>
<input class="fp aci_ref_number" name="aci_ref_number" value="" type="number">
</label>
<label> Name(s) of Account Holder(s) <span class="ff-req">*</span>
<input class="fp name_account_holder" name="name_account_holder" value="" type="text">
</label>
<label> DOB <span class="ff-req">*</span>
<input class="fp dp dp_input date_of_birth datepicker-input" name="date_of_birth" value="" type="text" placeholder="dd/mm/yyyy">
<div class="datepicker datepicker-dropdown">
<div class="datepicker-picker">
<div class="datepicker-header">
<div class="datepicker-title" style="display: none;"></div>
<div class="datepicker-controls"><button type="button" class="button prev-btn">«</button><button type="button" class="button view-switch">2000-2009</button><button type="button" class="button next-btn" disabled="">»</button></div>
</div>
<div class="datepicker-main">
<div class="datepicker-view years datepicker-grid"><span class="datepicker-cell year prev" data-year="1999">1999</span><span class="datepicker-cell year" data-year="2000">2000</span><span class="datepicker-cell year"
data-year="2001">2001</span><span class="datepicker-cell year" data-year="2002">2002</span><span class="datepicker-cell year" data-year="2003">2003</span><span class="datepicker-cell year" data-year="2004">2004</span><span
class="datepicker-cell year focused" data-year="2005">2005</span><span class="datepicker-cell year disabled" data-year="2006">2006</span><span class="datepicker-cell year disabled" data-year="2007">2007</span><span
class="datepicker-cell year disabled" data-year="2008">2008</span><span class="datepicker-cell year disabled" data-year="2009">2009</span><span class="datepicker-cell year next disabled" data-year="2010">2010</span></div>
</div>
<div class="datepicker-footer">
<div class="datepicker-controls"><button type="button" class="button today-btn" disabled="" style="display: none;">Today</button><button type="button" class="button clear-btn" style="display: none;">Clear</button></div>
</div>
</div>
</div>
</label>
<label> Bank/Building Society Account Number <span class="ff-req">*</span>
<input class="fp account_number" name="account_number" type="number">
</label>
<label> Branch Sort Code <span class="ff-req">*</span>
<input class="fp sort_code" name="sort_code" type="number">
</label>
<label> Name of Bank or Building Society <span class="ff-req">*</span>
<input class="fp bank_name" name="bank_name" type="text">
</label>
<label> Address of Bank or Building Society (optional) <input class="fp bank_address" name="bank_address" type="text">
</label>
<label> Postcode of Bank or Building Society (optional) <input class="fp bank_postcode" "="" name=" bank_postcode" type="text">
</label>
<label> Is the Account in your Name? <span class="ff-req">*</span>
<select class="fp yn wrn_chk account_in_your_name" name="account_in_your_name">
<option value="" selected="selected">- Select -</option>
<option value="yes">Yes</option>
<option value="no">No</option>
</select>
</label>
<label> Are you the Only Signatory Required to Authorise the Direct Debit? <span class="ff-req">*</span>
<select class="fp yn wrn_chk account_only_signatory" name="account_only_signatory">
<option value="" selected="selected">- Select -</option>
<option value="yes">Yes</option>
<option value="no">No</option>
</select>
</label>
<label> Are you making a One-Off or Recurring Payment? <span class="ff-req">*</span>
<select name="payment_type" class="fp sel payment_type">
<option value="" selected="selected">- Select -</option>
<option value="recurring">Recurring Payment</option>
<option value="single">One-Off Payment</option>
</select>
</label>
<div class="group_pt group_pt_single" style="display:none">
<label> I would like my One-Off Payment to be Taken on: <span class="ff-req">*</span>
<input class="fp dp dp_input payment_date payment_date_single" name="payment_date_single" value="" type="text" placeholder="dd/mm/yyyy">
</label>
<label> Select your One-Off Payment Amount <span class="ff-req">*</span>
<select class="fp curr payment_amount payment_amount1 payment_amount_single payment_amount_single1" name="payment_amount_single1">
</select>
</label>
<label style="display:none"> Enter your One-Off Payment Amount <span class="ff-req">*</span>
<input class="fp curr wrn_chk payment_amount payment_amount2 payment_amount_single payment_amount_single2" name="payment_amount_single2" value="" type="number" placeholder="£">
</label>
</div>
<div class="group_pt group_pt_recurring" style="display:none">
<label> Select your Recurring Payment Frequency <span class="ff-req">*</span>
<select name="payment_frequency" class="fp sel payment_frequency">
<option value="" selected="selected">- Select -</option>
<option value="monthly">Monthly</option>
<option value="four_weekly">Four Weekly</option>
<option value="fortnightly">Fortnightly</option>
<option value="weekly">Weekly</option>
</select>
</label>
<label style="display:none"> I would like my Monthly Recurring Payment to be Taken on: <span class="ff-req">*</span>
<select name="payment_day_monthly" class="fp sel payment_day_monthly">
<option value="" selected="selected">- Select -</option>
<option value="last_working_day">Last Working Day</option>
<option value="last_working_friday">Last Working Friday</option>
<option value="first_working_day">First Working Day</option>
<option value="1st">1st</option>
<option value="2nd">2nd</option>
<option value="3rd">3rd</option>
<option value="4th">4th</option>
<option value="5th">5th</option>
<option value="6th">6th</option>
<option value="7th">7th</option>
<option value="8th">8th</option>
<option value="9th">9th</option>
<option value="10th">10th</option>
<option value="11th">11th</option>
<option value="12th">12th</option>
<option value="13th">13th</option>
<option value="14th">14th</option>
<option value="15th">15th</option>
<option value="16th">16th</option>
<option value="17th">17th</option>
<option value="18th">18th</option>
<option value="19th">19th</option>
<option value="20th">20th</option>
<option value="21st">21st</option>
<option value="22nd">22nd</option>
<option value="23rd">23rd</option>
<option value="24th">24th</option>
<option value="25th">25th</option>
<option value="26th">26th</option>
<option value="27th">27th</option>
<option value="28th">28th</option>
<option value="29th">29th</option>
<option value="30th">30th</option>
<option value="31st">31st</option>
</select>
</label>
<label> I would like my Recurring Payment to Start on: <span class="ff-req">*</span>
<input class="fp dp dp_input payment_date payment_date_first" name="payment_date_first" value="" type="text" placeholder="dd/mm/yyyy">
</label>
<label> Select your Recurring Payment Amount <span class="ff-req">*</span>
<select class="fp curr payment_amount payment_amount1 payment_amount_recurring payment_amount_recurring1" name="payment_amount_recurring1">
</select>
</label>
<label style="display:none"> Enter your Recurring Payment Amount <span class="ff-req">*</span>
<input class="fp curr wrn_chk payment_amount payment_amount2 payment_amount_recurring payment_amount_recurring2" name="payment_amount_recurring2" value="" type="number" placeholder="£">
</label>
</div>
<label>
<strong>Instruction to your bank or building society</strong> Please pay ACI-UK Limited Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this
Instruction may remain with ACI-UK Limited and, if so, details will be passed electronically to my bank/building society. </label>
<label> Signature (Please enter your initials) <span class="ff-req">*</span>
<input class="fp signature" name="signature" type="text">
</label>
<div class="dd-guarantee">
<img src="https://www.aciuk.co.uk/wp-content/uploads/2022/02/dd-guarantee.jpg">
</div>
<label>
<input class="fp yn terms" name="terms" type="checkbox" value="yes"> I confirm that all my priority bills such as mortgage or rent, Council Tax and utilities are up to date, or if not, they are in a repayment plan and the payment amount on this
form is both affordable and sustainable. <span class="ff-req">*</span>
</label>
<label>
<input class="acisub acisub1" name="" type="submit" value="Submit">
</label>
<input class="fp hf form_src" name="form_src" type="hidden" value="">
<input class="fp hf contact_number" name="contact_number" type="hidden" value="">
<input class="fp hf contact_email" name="contact_email" type="hidden" value="">
<div class="acitok" style="display:none">obhz3juFFPs1s8eZ04o2JUfj3DpIG/RIPSurUtwnvferasST45IU1mvhAjKCNQ7eEo1If8Wrh7aLRTqT</div>
</div>
</form>Text Content
Skip to content Open toolbar Accessibility Tools Accessibility Tools * Increase TextIncrease Text * Decrease TextDecrease Text * GrayscaleGrayscale * High ContrastHigh Contrast * Negative ContrastNegative Contrast * Light BackgroundLight Background * Links UnderlineLinks Underline * Readable FontReadable Font * Reset Reset * SitemapSitemap * HelpHelp * FeedbackFeedback Login Make a Payment * Home * Payment Options * Contact Us * FAQs * About Us * Customer Feedback * Additional Help & Tips Customer Login Make a Payment ACI is part of the perch group of companies Navigate to another company PERCH GROUP Parent CompanyFind out more PERCH CAPITAL Debt PurchaserFind out more TM LEGAL Debt recovery solicitorsFind out more FIELDCONNECT Reconnection specialistFind out more Home > Form – DD SET UP A DIRECT DEBIT Setting up a Direct Debit is quick and easy. INSTRUCTION TO YOUR BANK OR BUILDING SOCIETY TO PAY BY DIRECT DEBIT ACI Customer Reference * Name(s) of Account Holder(s) * DOB * «2000-2009» 199920002001200220032004200520062007200820092010 TodayClear Bank/Building Society Account Number * Branch Sort Code * Name of Bank or Building Society * Address of Bank or Building Society (optional) Postcode of Bank or Building Society (optional) Is the Account in your Name? * - Select - Yes No Are you the Only Signatory Required to Authorise the Direct Debit? * - Select - Yes No Are you making a One-Off or Recurring Payment? * - Select - Recurring Payment One-Off Payment I would like my One-Off Payment to be Taken on: * Select your One-Off Payment Amount * Enter your One-Off Payment Amount * Select your Recurring Payment Frequency * - Select - Monthly Four Weekly Fortnightly Weekly I would like my Monthly Recurring Payment to be Taken on: * - Select - Last Working Day Last Working Friday First Working Day 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st I would like my Recurring Payment to Start on: * Select your Recurring Payment Amount * Enter your Recurring Payment Amount * Instruction to your bank or building society Please pay ACI-UK Limited Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with ACI-UK Limited and, if so, details will be passed electronically to my bank/building society. Signature (Please enter your initials) * I confirm that all my priority bills such as mortgage or rent, Council Tax and utilities are up to date, or if not, they are in a repayment plan and the payment amount on this form is both affordable and sustainable. * obhz3juFFPs1s8eZ04o2JUfj3DpIG/RIPSurUtwnvferasST45IU1mvhAjKCNQ7eEo1If8Wrh7aLRTqT PLEASE CHECK ALL YOUR DETAILS ARE CORRECT BEFORE SUBMITTING ACI Customer Reference Name(s) of Account Holder(s) DOB Bank/Building Society Account Number Branch Sort Code Name of Bank or Building Society Address of Bank or Building Society Postcode of Bank or Building Society Account In Your Name Only Signatory Required Direct Debit Payment Type One-Off Payment Date One-Off Payment Amount Recurring Payment Frequency Monthly Recurring Payment Day First Recurring Payment Date Recurring Payment Amount Signature (initials) Priority Bills up to date If there are any changes to the amount, date or frequency of your Direct Debit ACI-UK Limited will notify you 3 working days in advance of your account being debited or as otherwise agreed. If you request ACI-UK Limited to collect a payment, confirmation of the amount and date will be given to you at the time of the request. Your Direct Debit will be collected using the following details: Service User Number (SUN): 185882, Service User Name: ACI-UK Limited Confirmation of the Direct Debit set up will be sent via email within 3 working days or if the first collection is within 1 month from sign up no later than 10 working days before the first collection. Contact us: Telephone: 01253 531528 Email: support@assetcollections.uk Post: ACI, Unit 10, Whitehills Business Park, Whitehills Drive, Blackpool, Lancashire, FY4 5LW This site is secured by SSL encryption. For more information, click the padlock in the address bar or the site seal below. Go back Home About Us Contact Us Payment Options FAQs Help & Advice Customer Login Privacy Policy Terms and Conditions Complaints Connect with us Linked In ACI is a trading name of ACI-UK Limited. Company registration number 03775287. Incorporated in England and Wales. Registered Offices: 10 Whitehills Business Park, Whitehills Drive, Blackpool, Lancashire FY4 5LW. Authorised and regulated by the Financial Conduct Authority for Consumer credit regulated activity, Firm Reference No. 708400. Registered with the Information Commissioners Office, Registration No: ZA116228. Credit Services Association Membership No. 987 (CSA Code of Practice). We use cookies to ensure that we give you the best experience on our website.OkPrivacy policy