Direct Debit Mandate for Leaseholders - Service Charges

Address
1. Is direct debit instruction for a:
  
  Flat
2. Please give the address of the Leasehold account which this request relates
  1. Postcode
    
    Address
3. Postcode
4. Label
  2. Address
  3. (optional)
  4. (optional)
  5. Town
  7. Give the payment reference number (if known) (optional)
5. Authority
  1. Does the bank account used to create this direct debit belong to:
  2. If you are not a leaseholder of the property, do you consent to this direct debit being set up from your account to cover payments for service charges and any arrears agreed by the leasholder and the council?