Bank GIRO Termination Form
Submit this form to request cancellation of your existing bank GIRO arrangement. All fields are required to process your request.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Bank Name
*
GIRO Arrangement Reference or Description
*
Reason for GIRO Termination
*
Please Select
Account closed
Switching to another payment method
Service no longer required
Duplicate GIRO arrangement
Other
Effective Termination Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are there any outstanding payments to be processed before termination?
*
Yes
No
If yes, please specify how you wish to handle outstanding payments
Additional Comments (optional)
I confirm that the information provided is accurate and I authorize the termination of my GIRO arrangement as specified above.
*
I confirm
Submit Request
Should be Empty: