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