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Business Rates - Request to Pay by Direct Debit

If you wish to pay your Business Rates by direct debit, please fill in this form to receive a blank direct debit form through the post.

Contact details

Help IconPlease enter details manually if address lies outside the Dudley borough.

Review & submit

Before you submit:

  • Review your completed request
  • Print or save this review copy for your own records, or
  • If you wish to receive an email copy of your request, ensure you have entered a email address.
Yes, I wish to receive an email copy of my request.

Data Protection Statement

The information you provide on this form is subject to the provision of the Data Protection Act 1998. The information will be held confidentially and will be retained for the purposes of processing your request and meeting our statutory obligations. It may be used for council tax and housing benefits, rent accounting purposes, the administration and collection of other local taxes and charges and for the purposes of performing other statutory enforcement duties.

Please refer to our Privacy & Disclaimer Statement below for our Information Charter and general information on our approach to security, confidentiality, data collection, etc.

Further data protection information can be obtained from the Information Commissioner's website at
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