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:
...................................................................
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:
.....................................................
Yearly
commencing on 1st April
................
£.................
Please use my name as reference on payments
Debit my A/c No: ...............................................
Sort Code:........................................
Signature:............................................................. Date: ..........................................