Direct Debit application form

If you would like to request a form to pay your Council Tax or Business Rates by Direct Debit, please complete the information requested on the following pages.

The information you provide will be treated as confidential.

Should you have an enquiry about this service, please contact us on 0116 252 7005.

Fields marked with * are mandatory

Title*
First name*
Surname*
House number/name*
Street*
Town*
Postcode (if known)*
Telephone number*
Email address
What do you wish to pay by Direct Debit?
Form:*
Council Tax/Business Rates reference number
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