STANDING ORDER FORM - Download as DOC

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					STANDING ORDER FORM
1. Your details
Your full name                                    Bank                    Your account number


Contact phone number                              Branch name                       Sort code



2. Details of your standing order
Recipient’s name:                         Gloucester Rowing Club
Recipient’s bank & branch name            Lloyds TSB Cheltenham High Street Cheltenham
Recipient’s sort code                     30-91-87
Recipient’s account number:               00513706

Usual payment amount:                     £

First Payment date:                       D D      M M       Y Y    (to be no later than the 25th of the month)


Final payment date:                       D D      M M       Y Y or until further notice

How often do you want the payment made?         Monthly

Your payment reference:

3. Authorisation
I authorise you to debit my/our account, in accordance with the details in section 2. This request
is addressed to the bank that holds my/our account.

Your signature(s)


Date


Please ensure that your name is included in the payment reference

Once you have completed this form please forward it to your bank

				
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posted:11/21/2010
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