Braunton Cricket Club 125 - Standing Order Mandate

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

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: ..............................................................................