Page 24 - SpringSummerNL22

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

24