I wish to pay the annual subscription to The Metcalfe Society by standing
order. Please tick relevant box :
 This is a new
instruction.
Please amend
previous standing order
|
| Account to be debited
:- |
| Name of Bank: |
_________________________ |
| Sort Code: |
_________________________ |
| Branch: |
_________________________ |
| Account Number: |
_________________________ |
| Account Name: |
_________________________ |
| |
| Beneficiary Bank :- |
Barclays Business Centre |
| Sort Code: |
20-78-42 |
| Branch: |
Barclays Business Centre,
PO Box 1, 49 High Street,
SKIPTON BD23 1DH |
| Account No: |
00028673 |
| Account Name: |
The Metcalfe Society |
| |
Payment Details
Amount of First Payment: £________ (insert amount due for this year)
Date of First Payment: ____________ (insert a date in the next two weeks)
Amount of Regular Payment: £ _________ (insert subscription amount due in
future yrs)
Amount of Regular Payment in words:
_____________________________________________________________
Date of Regular Payment: _____________ (insert a specific date in January e.g.
20 Jan.)
When paid: Annually
Complete either of the following (but not both): |
| Amount of Last Payment: £ |
_____________________________ |
| Date of Last Payment: |
_____________________________ |
| OR Please continue
payments until further notice: Yes (please tick)
|
| Authorisation |
| Signature(s): |
_____________________________ |
| Name (please print clearly): |
_____________________________ |
| Date : |
_____________________________ |
| Metcalfe Society member no.: |
_____________________________ |
| Daytime telephone: |
_____________________________ |
| |
ALL lines must be
completed in order for the standing order to be processed.
February 2002 |
