debit card payments

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CREDIT/DEBIT CARD PAYMENTS The Loughborough is pleased to be able to offer you the opportunity to pay your mortgage fees by Debit/Credit card. If you wish to take advantage of this easy payment method please complete and sign the form below. THE PAYMENT DATE WILL BE CONFIRMED BY TELEPHONE PRIOR TO ANY DEBIT BEING MADE.

Card Holder Name………………………………………………………………………….………….……………………………………………… Card Statement Address…………………………………………….…………………….………………………………………………………. …………………………………………………………………………………………………………..…Post Code…….…….………..…………… Please debit £…………………………………from my debit/credit card account Card Type……………………………….………e.g. Visa Debit/Visa Credit/Mastercard (we don’t accept American Experss) Card Number - between 13 & 19 digits

Sort Code……………………………………………….……Issue Number (where applicable)…….…………………………………. Expiry Date………………………………..…………….…Security Number (where applicable)……………………………..……. Daytime Telephone Number/s………………...………….…………………………………………….…………………………………….. Signature………………………………………….…………………….………………………………Date……………………….………………… Mortgage Account Number………………………….……………………………………………..……………….…………………………… Mortgage Account Name………………………….………………………………………………………………….……………………………

For Office use only: Signature checked by

Fee to be paid

Customer Notified

Processed by

Authorisation Code

Finance Notified

Process Date

The Loughborough Building Society is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and Prudential Regulation Authority.Financial Services Register number 157258.