STANDING ORDER MANDATE

                                            (Please type details below and then print form)

Your Full Name:

Your Address:

To The Manager:

Your Bank Name:

Your Bank Address:

Your Bank Account Number:

Your Bank Sort Code:

Please Pay:

Payee Bank Name:

H.S.B.C. Bank Plc.

Payee Account Name:

Payee Sort Code:

40-12-04

Payee Account Number:

61795716

Payment Amount:

Select Amount: £5.00 £10.00 £15.00 £20.00 £25.00 £30.00 £35.00 £40.00 £45.00 £50.00 £55.00 £60.00 £65.00 £70.00 £75.00 £80.00 £85.00 £90.00 £95.00 £100.00

Frequency:

Select Frequency: Every Week Every Month

Date of First Payment:

Select Day: 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Select Month: January February March April May June July August September October November December Select Year: 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Reference:

Select Reference: General Donation Pupil Sponsor

Signature:

Print Your Full Name:

This form should be completed and forwarded to your own Bank.