GoCardless - Home or Utilities Cover Form + Refunds + 3x

To get help faster, please check this important information about contacting Support.

Please enter the details of your request. A member of our support staff will respond as soon as possible.

For example, for the UK this will be the Companies House registrar entity number

For example, you expect to process £200,000 through GoCardless in the next 12 months in total please only insert: 200000

Please state this as a number, not a % i.e if 60% please only insert '60'

*Please insert this as a number only* for example if it is 40 days, please only insert: 40. If there is a further fulfilment split, i.e. 20% is 30 days and 40% is 365 days, then please insert the weighted days ( (20%*30) + (40%*365)). In this example the output would be: 152.

For example, monthly installments towards annual boiler servicing plans, plus adhoc call out fees.

For example, each maintenance plan includes a guaranteed annual boiler service.

For example, digital marketing, advertising, word of mouth referrals, outbound prospecting

If you are not yet using Direct Debit as a payment method, please confirm you current method & number of customers

Please select the % of chargebacks in value terms

Please select the % of failures in value terms

Do you expect to process refunds through GoCardless?

This is required to validate the projections of the business against funding provided

Please can you attach this to the form. This is required to understand further the future projections of the business

This is to understand the growth plans of the business further

Add file or drop files here