If you have a printer, you can set up, cancel or amend a Payment by filling in this form, printing it and taking it to any Nationwide branch
Bill Payment Authority Form


Please complete this form, then either post or take the completed form to your branch.

Please select the option you require
New authority Amend existing authority Cancel existing authority


Name of the Organisation to be paid
Organisation's Address
Postcode 
Organisation's Bank
Bank Sort Code  Bank Account Number 

Your Reference/Account Number with the Organisation
Please describe the Payment in not more than 14 characters
(this will appear on the Payment ID list when you make a payment) 

 
Your Name(s)/Account Name
Your Branch Prefix Your FlexAccount Number 6
 

Signed ......................................................................................
Signed ......................................................................................
Date: ........................................

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