Border Collie Rescue - Standing Order Donation Form |
For Welfare Funds |
Border Collie Rescue, 57,Market Place, Richmond, North Yorkshire, DL10 4JQ. 0845 6044941 |
To make regular
standing order payments to Border Collie Rescue, please fill in this mandate and hand it
in to your bank. Please Use Block Capitals.
|
TO ___________________________________ Bank. Sort Code _ _ _ _ _ _ : |
Branch______________________________________________________: |
A. Customers details. |
Account Name _____________________________: |
Account Number _ _ _ _ _ _ _ _: |
Tel Number - Work __________________: Home ___________________: |
Please set up the following standing order and debit my/our account accordingly - |
B. Beneficiary details. |
Pay to the account of BORDER COLLIE RESCUE WELFARE FUND at NATIONAL WESTMINSTER BANK - MARKET PLACE - RICHMOND - NORTH YORKSHIRE. |
Account Number 4 6 1 6 5 4 0 1 Sort Code 5 4 - 3 0 - 4 3 |
Reference to be quoted (if any)_______________________________________: |
C. Payment details. |
Please Pay to the above beneficiary - |
The sum of £________: In words______________________________________: |
Commencing On _____________________date and thereafter Monthly. |
Total Number of Payments _____ OR Expiry date __/__/____ OR Until Further Notice ___ Tick. |
I / We acknowledge that the bank will not undertake to : (1) make any references to VAT or other indeterminate element - (2) advise payees address to beneficiary - (3) advise beneficiary of inability to pay - (4) request beneficiaries banker to advise beneficiary of receipt |
Customers signature/s _____________________________________________________: |
Date _____________________: |
Bank Use Only - Keyed By __________ (initials). Date ________________: |
Served By ______________________ at __________________________ Branch |
ITS No _____________________ External No ______________________ |