To: (Bank) ................................................................................................................................................................................................................

 

Postal Address: ..........................................................................................................................................................................................................

  Bank Branch Address Sorting Code Number
Please pay : Lloyds TSB 17 Cross Street, Barnstaple, EX31 1BE 30 - 90 -49
  Beneficiary's Name Account Number Quoting Reference
for the credit of : Braunton Cricket Club 125 0 7 3 5 3 1 8 -  
  Amount Amount in words
the sum of : £5.00 Five pounds only
  Date of first payment and thereafter every Due date and frequency until further notice in writing or Date of last payment and debit my/our account accordingly
comencing : 28th (3) ..... 2007 Month 28th of the month              
 
PLEASE CANCEL ALL PREVIOUS STANDING ORDERS/DIRECT DEBIT MANDATES IN FAVOUR OF UNDER REFERENCE NUMBER Account to be debited Account Number
                     

Special instructions

 

 

 

Signature(s): ....................................................................................................................... Date: ..............................................................................