Direct Debit Form

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Country of residence*

First Name*

Last Name*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

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Mobile Number*

BANK NAME

ACCOUNT NUMBER

SORT CODE

Preferred Monthly Direct Debit Date*

Child 1: Full Name*

Year Group

If you have more than one child enrolled please add them below

Yes

Child 2: Full Name

Year Group

Child 3: Full Name

Year Group

Child 4: Full Name

Year Group

Registered

Haya Girl school Independent School helps you save both time and money since it is offered anywhere worldwide, without anyone having to travel.