rollerski club - standing order form

Either use internet banking to set up your own regular payment to: Rollerski Instruction, A/C 61604937 Sort Code: 40-02-03 Or complete (print) the bankers order form:

To the Bank Manager (Name of Bank) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Branch Address. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Postcode . . . . . . . . . . . . . . . . .

Sort Code .........-.........-......... Account No. . . . . . . . . . . . . . . . . . . . .

Please pay Rollerski Instruction (rollerski club)

£ 25 / 35 every month (delete as applicable, £25 if you use your own equipment, £35 if you need to borrow our equipment)

Start on ...../...../..... (date) until further notice.

Name (Mr/Ms/Mrs/Miss/Dr). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Signature . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Postcode. . . . . . . . . . . . . . . . . . . .

FOR BANK USE: Please use our ref: A/C 61604937 Sort Code: 40-02-03

Please send this to your bank, with instructions to set up this standing order.