Page 18 - SpringSummerNL20
P. 18
BANK STANDING ORDER MANDATE
Full name………………………………………………………………………...…………………...………………
Address…………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………
………………………………….…….....……………………………….………………………………………..…..
…………………………………....Postcode………………………………………..………………..…..…
I would like to help Greyhounds in Need CIO with an annual /
quarterly / monthly gift of £……………………..
Name of your bank……………………………………………………………………………………………….
Address of your bank………………………………………………………….…………………………...
……………………………………………………………………………………………...…………………...………...
………………………………………………………………………………………………………….……………………….
………………………………………………………………………………………………………………...……………….
……………………………………………………………………………………………………………………….…………..
………..…………………………………………………………....Postcode…………………...…..…………
Bank sort code …..-…….-……Account Number………………………………………….…..
Bank Instruction:- Please pay the stated amount on the same day
each year / quarter / month, starting on / / /
REFERENCE:……………………………………………………………...
Signature ………………………………………………………Date……………………………………………….
Please send this form to your bank
PLEASE PAY: Coutts & Co., 440 The Strand, LONDON WR2R 0QS.
Account - Greyhounds in Need CIO
Account Number 04781600 Sort Code 18-00-02
IBAN GB78COUT18000204781600 BIC COUTGB22
18