By completing this form you authorise Virgin Media to send instructions to your bank to debit your account in accordance with the instructions from Virgin Media. As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited. Your rights are explained in a statement that you can obtain from your bank. The amounts are variable and maybe debited in various dates in accordance with your billing frequency.