Standing Order Form

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Please print this page out and send the completed upper half of this form to your Bank.

    TO ………………………………………… (Name of your Bank)

      BANK ADDRESS………………………………………………….

     ……………………………………………………………………….

     ……………………………………………………………………….

     Please Pay

Bank:

Branch Title:

Sort Code:

Account No:

Lloyds TSB

Sandown

30-97-42

00569653

The sum of:

Commencing:

Frequency:

£5.00 (Five pounds)

1 February

Annually

Reference:

Account Name:

…….. / ………….

Upper Chine School Old Girls Association

Ref = Year of leaving plus your initials

     Please debit my / our account accordingly

    Account name to be debited ……………………………….Account No…………………

     Signature(s) ………………………………………………..

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PLEASE DETACH, COMPLETE AND FORWARD TO:-

 Ms Liz Rogers, Campion Cottage, Lydford, Okehampton, Devon EX20 4BL

 Re:  UPPER CHINE SCHOOL OLD GIRLS’ ASSOCIATION

I confirm I have forwarded the Standing Order Mandate to my bank requesting them to pay £5                                       to the account of Upper Chine School OGA annually, with effect from next February.

      Signed ……………………………………             Date ………………………………….

      Print Name ………………………………..           Maiden Name…………………………

     Address…………………………………….           Year of Leaving School ……………..

      ………………………………………………          Ref given on S/O Form:   .....................

      Post Code:…………………………………          Email: ………………………………….