Free Direct Debit Authorization Form

To obtain the direct debit authorization, go to Google and type adp.pdf; the first link will provide the authorization in PDF format.

Direct debit authorization? To be sent to your bank along with a bank account details document (RIB).
I authorize the institution maintaining my account to debit from it, if its situation allows, all payments ordered by the creditor designated above. In case of a dispute regarding a direct debit, I can request to suspend its execution by simply asking the institution maintaining my account. I will settle the dispute with Free Telecom.
National issuer number: 459654
Institution maintaining the account to be debited
Bank: ......................................................................
Address: .....................................................................
....................................................................................
Postal Code: .........................
City: ...........................................................................
NAME, FIRST NAME AND ADDRESS OF THE DEBTOR
Company: ....................................................................
Last Name: ........................... First Name: ..............................
Address: ...................................................................
.................................................................................
Postal Code: ......................... City: ......................................
Account to be debited
Institution Counter No. of account Key RIB
|_|_|_|_|_| |_|_|_|_|_| |_|_|_|_|_|_|_|_|_|_|_| |_|_|
Name and address of the creditor
FREE TELECOM - 75371 PARIS CEDEX 08
Made in: ..................................... On: ...............................
Signature (mandatory):
- don't forget to attach your RIB -