STANDING ORDER MANDATE To:……………………………………………………………….(Insert name and ………………………………………………………………..….address of your bank. ………………………………………………………………...…Please include the …………………………………………………………..……….Post Code)

Sort Code:……………………………Account Number:……………….……………. Account Name:……………………..……………………………………………………. Please pay the sum of: £5.00(Five Pounds)* / £10.00(Ten Pounds)* / £15.00(Fifteen Pounds)* (*Please delete the values that you do not wish to pay)

On the first day of ……………………201… and thereafter on the first day of each month until further notice. To:

Lloyds TSB Bank 12, High Street Haslemere Surrey GU27 2JG

Sort Code: Account Name:

30-93-94 Account Number: 01256294 Milland Valley Memorial Hall

SIGNED:…………………………………………………………………………………… Please Print Name:…………………...……………………………………………….… Address:…………………………………………………………………………………... ……………………………………………………………………………………………… ……………………………………………………………………………………………… Telephone Number:……………………………………………………………………... E-Mail address:…………………………………………………………………………... Please complete and return this form to: Mr John Collier, 6 Drakeleys Field, Milland, Liphook, GU30 7NH Tel: 01428 741225 E-Mail: [email protected] MVMH Club No.:…………………….

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