Border Collie Rescue - Standing Order Donation 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 ________: 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 ______________________