STANDING ORDER MANDATE

To ________________________________________ Bank

Address: ________________________________________

________________________________________________

________________________________________________
Please insert the name and address of your bankers

Please pay
THE CO-OPERATIVE BANK STOCKPORT
08-92-99

For the credit of VIKING SUPPORTERS’ CO-OPERATIVE
Account number 65060234

The sum of

First Payment £____________ (____________________________________________)
(Amount in figures) Amount in words

Date of first payment

_____________________________/NOW (delete as required)

and £_______thereafter _________________________________weekly/monthly (delete as required)
(due date and frequency)

Until you receive further notice from me/us in writing

Quoting Viking Supporters Co-operative Membership No: _______________________and debit my/our account accordingly.

Please cancel any previous standing order or direct debits in favour of the beneficiary named above under this reference.

Account to be debited _____________________________________________
Bank account name

Account number ___ ___ ___ ___ ___ ___ ___ ___ ___ ___


__ __ - __ __ - __ __ - __ __
sorting code

 

Signature(s) ___________________________________________


_____________________________________________________

Date: ________________________________________________

Note: Please ensure the above is signed in accordance with the account mandate.