Border Collie Rescue - Central Fund Standing Order Form

For Central Funds
Registered Office - Border Collie Rescue, 57,Market Place, Richmond, North Yorkshire, DL10 4JQ. 0845 6044941
To make a regular standing order payment to Border Collie Rescue, please fill in this mandate and hand it in to your bank. Please Use Block capitals
TO ___________________________________ Bank. Sort Code _ _ _ _ _ _ :
Branch______________________________________________________:
A. Customers details.
Account Name_____________________________:
Account Number _ _ _ _ _ _ _ _ :
Tel Number - Work __________________: Home ___________________:
Please set up the following standing order and debit my/our account accordingly -
B. Beneficiary details.
Pay to the account of BORDER COLLIE RESCUE at NATIONAL WESTMINSTER BANK - MARKET PLACE - RICHMOND - NORTH YORKSHIRE.
Account Number 4 6 1 6 5 3 9 8 Sort Code 5 4 - 3 0 - 4 3
Reference to be quoted (if any) _______________________________________:
C. Payment details.
Please Pay to the above beneficiary -
The sum of Ł ________: In words ______________________________________:
Commencing On _____________________ date and thereafter Monthly.
Total Number of Payments _____ OR Expiry date __/__/____ OR Until Further Notice ___ Tick.
I / We acknowledge that the bank will not undertake to : (1) make any references to VAT or other indeterminate element - (2) advise payees address to beneficiary - (3) advise beneficiary of inability to pay - (4) request beneficiaries banker to advise beneficiary of receipt
Customers signature/s _____________________________________________________:
Date _____________________:

Bank Use Only - Keyed By __________ (initials). Date ________________:
Served By ______________________ at __________________________ Branch
ITS No _____________________ External No ______________________