Update Payment Method via Bank Direct Debit – digital-services.priority-software.com

Update

Payment Method via Bank Direct Debit

To update your payment method to a bank direct debit, please fill in the required details in this form. The authorization must be without a limit on the amount and without a limit on the date. Priority Institution Code 47815

Request Date *

Customer Details

Company Name(Hebrew) *

Company Name (English)

Company ID *

Requester name *

Requester email *

Requester phone number *

(Example: ‎03-925-1000 or ‎0535-400-005)

Bank Details

Bank name *

Bank department number *

Account number *

Account holder name *

By submitting the form, I confirm the update of the payment method as a permanent payment method according to the above information and authorize the execution of the direct debit by my bank.

Manual signature field *

For processing the order, please attach the complete order form. *

Customer Comments