Standing Order Form

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Please print this page out and send the completed upper half of this form to your Bank.

To (name of your Bank)  : ...............................................................................................................

Address                          : ...............................................................................................................

                                        .............................................................................................................. 

Please pay :  LLOYDS Bank,        Branch Title :  SANDOWN,      Sort Code :  30-97-42

For the Credit of                : UPPER CHINE OLD GIRLS ASSOCIATION

Account Number               :  0 0 5 6 9 6 5 3

The sum of                       :  £5.00  (five pounds)

Commencing                    :  1st February 200_  and thereafter every year until further notice from me/us in writing

Reference                           : ................/..............  (give year of leaving followed by initials)

AND DEBIT MY/OUR ACCOUNT ACCORDINGLY

Account Name to be debited : .............................................................................................................

Account Number                  : .............................................................................................................

SIGNATURE (S)                  : .............................................................................................................

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CONFIRMATION OF STANDING ORDER SET UP

Please detach this section and forward it to :   Mrs E Mayson, Greywalls Lodge, Hillbrow, Liss, Hants, GU33 7QR

I confirm I have forwarded the Standing Order Mandate to my bank requesting them to pay £5.00 to the account of Upper Chine OGA annually, with effect from February 200_

Signed                                : .............................................................................................................

Print Name                         : .............................................................................................................

Address                             : .............................................................................................................

                                           .............................................................................................................

                                           .............................................................................................................

Date   : .................................................      Maiden Name : ..............................................................

Year Left School : .................................       Standing Order Reference : ......................./....................