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Mr/Mrs/Miss/Other
(please delete as applicable) Address: Postcode:
Telephone:
Email: Please
complete and return this form with Standing Order Request or
cheque/cash to: The
Membership Secretary Cheque/postal order enclosed Bankers order sent Subscription Rates:
For printer friendly version for payment by standing order request click here Standing
Order Request
To
the Manager
………………………………………………………………
Bank
plc Address
of Bank: Postcode: Please
pay to Lloyds TSB Bank plc, sort code 77-25-13 NOW* and on the 1st
of November each year until further notice the sum of: *
delete
"NOW* and" if dated between 1 September and 31 October This
cancels any existing order to The Portchester Society Signed:
……………………………………………………………
Date ………………………….…. Full
Name (Block Letters):
…………………………………………………………………………… Address:
………………………………………………………………………………………………… …………………………………………………………………
Post Code: ……………………………
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