Please return this form to us - NOT to your bank.
Please PRINT IN CAPITALS
Part 1
MEMBERSHIP
Name: ................................................................................
Address: ............................................................................
...............................................................................
.............................................................................
Post Code: ...............................
Tel No.: ................................................
E-mail:
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Part 2
STANDING ORDER
TO:
Name and address of your bank:
The Manager
..................................................................................
.................................................................................
.................................................................................. Post Code: ..............................
PAY TO: Gosport Society
A/c No.: 40966415 - Sort
code: 09-06-66
Abbey Business Banking,
301 St Vincent Street, Glasgow, G2 5HN.
Immediately the sum of: £ ....................
Usual payment:
..................................................... On 1st April
Yearly
£.................
Please use my name as reference on payments
Debit my A/c No:
............................................... Sort Code:........................................
Signature:.............................................................
Date:
............................................................