Corporate Membership Direct Debit

You have been sent the link to this page so that you can setup the Direct Debit for your Xcite Corporate Membership.

If you have any issues completing this form, please email our Membership team xciteonline@westlothianleisure.com

CORPORATE MEMBERSHIP DIRECT DEBIT MANDATE FORM

Bank detail confirmation

Please confirm that you are the account holder and have authorisation to set up direct debits on this account.

Yes

Under the DD Guarantee, only the account holder can set up DD instructions against the account. If you are not the account holder, you will need to complete a paper Direct Debit Instruction. Please email xciteonline@westlothianleisure.com to arrange this.

I understand

Please enter your personal details, the details you have entered must match what you have provided on your application form.

Title

Mrs

Miss

Other

If other, please state below

First name

Middle name(s)

Surname

Contact phone number

Email address

Postal address

Postcode

Membership number

Date of Birth

Please use this space to give us any additional relevant information

Corporate Membership Direct Debit

CORPORATE MEMBERSHIP DIRECT DEBIT MANDATE FORM

Bank detail confirmation

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