STANDING ORDER MANDATE

Your bank

………………………………………………………………..

Bank’s address:

…………………………………………………. ………………………………………………….. …………………………………………………. ………………………………………………….. ……………………………….

Post code:

Please set up the following Standing Order and debit my/our account accordingly: Customer details: Account name

………………………………………………………….

Sort Code

……………………………..

Account No.

…………………………………

Organisation I/we wish to Pay: Name:

PCC Rudgwick Young People

Bank:

Lloyds TSB Bank 1 West Street Horsham West Sussex RH12 1PA

Account No.

00609100

Sort Code:

30-94-41

The sum of (in figures) £……………………………………. (in words) …………………………………………………….. Commencing on ………………………………………….(date) And thereafter each month/quarter/year (delete as appropriate) and debit my/our account accordingly.

Signature

…………………………………………………

Date

…………………………………………..