To ………………………………………………………………………………………………………….

Address ……………………………………………………………………………………………………

……………………………………………………………………….Post Code………………………….

Please contact Treasurer or Secretary for Bank Details

The sum of £…………………… (figure in words) …………………………………………………………

Commencing on the (date of first payment)……………………………………………………………………………….

And hereafter every (date and frequency) …………………………………………………………………………………

Until (date of last payment) …………………………………………………………………………………………………

And debit my account :-Please Quote Reference No. (for official use only)

 

 

 

 

 

 


Account Number

 

 

 

 

 

 

 

 

 

 

 

Sort Code

 

 

 

 

 

 

Date ………………………….. Signature ………………………………………..

Address ……………………………………………………………………………………………………

……………………………………………………………………….Post Code………………………….