200 Club – Application

 Please complete sections A, B F & G (in Italics) in BLOCK CAPITALS

A.    To: The Manager

…………………..……………………Bank Plc

………………………………………………..

……………………………………………….

……………………………………………….

B.      Your details:

·     Account in the name of      …………………………….

·     Account Number        …………………………….

·     Branch Name                  …………………………….

·     Sort Code                                -      -    

 C.     This is a new instruction and not an amendment to any existing standing order to this payee

 D.     Please pay to the following account:

·      Bank & Branch             Lloyds TSB, Dorking

·      Sort Code               30 – 92 – 70

·      Account Name                Effingham & Leatherhead RFC

·      Account Number       7356182

·      Reference               200 Club

 E.      Payment Details

·      Amount            £30 (Thirty Pounds)

·     Timing             On 1 September and then on subsequent anniversaries until further notice

F.  Signature                                                            Date:

 

G.  Contact Details (for Club use)

Your name                       ………………………………………

Address                           ………………………………………

                                       ………………………………………

Post Code                       ……………………..

Telephone Number:          ………………………………………