HILLSIDE HARVEST MEMBERSHIP AND STANDING ORDER MANDATE FORM
Please return this form to the treasurer Claire Gregory
Please complete in BLOCK CAPITALS
TITLE:
NAME:
ADDRESS:
POST CODE:
CONTACT NUMBER:
YOUR BANK NAME:
YOUR BANK ADDRESS:
YOUR ACCOUNT NUMBER: SORT CODE:
YOUR ACCOUNT NAME:
TYPE OF MEMBERSHIP YOU WISH TO HAVE:
CORE/CORE CONCESSION/ASSOCIATE/ASSOCIATE CONCESSION (Please delete accordingly)
Please debit the above account the following amount: £
Amount in words:
Every quarter/year (delete accordingly) starting on and on the same date accordingly.
Signature
Date
Please return this form to the treasurer Claire Gregory
Please complete in BLOCK CAPITALS
TITLE:
NAME:
ADDRESS:
POST CODE:
CONTACT NUMBER:
YOUR BANK NAME:
YOUR BANK ADDRESS:
YOUR ACCOUNT NUMBER: SORT CODE:
YOUR ACCOUNT NAME:
TYPE OF MEMBERSHIP YOU WISH TO HAVE:
CORE/CORE CONCESSION/ASSOCIATE/ASSOCIATE CONCESSION (Please delete accordingly)
Please debit the above account the following amount: £
Amount in words:
Every quarter/year (delete accordingly) starting on and on the same date accordingly.
Signature
Date