Text Box:   Subscription Payment Senior Player Please complete in BLOCK CAPITALS   Text Box:   A.   TO:  THE MANAGER   ....................................................................................BANK plc .................................................................................... .................................................................................... ....................................................................................                     C.   Instructions                            This Authority is a new instruction, and cancels any existing instructions.                           E.   Payment Details             Amount of Payment               Monthly on 1st day of each month, commencing 1st Month Next Following   Text Box: B.   Your Details             Account in the Name(s) of                                Branch Name               Account Number               Sort Code     Text Box:   Text Box:   Text Box:   Text Box:   Text Box:   Text Box:   Text Box:   Text Box:   Text Box:   Text Box: D.   Please pay to the following Account   Account Name               Bank and Branch               Account Number               Sort Code   Text Box: Effingham & Leatherhead RFC Text Box: LLOYDS DORKING Text Box: 1070406 Text Box: 30 - 92 - 70 Text Box:   Text Box: F.   Signature                                Date     Text Box: 2007-2008