Standing Order Mandate

Kindly complete (using your keyboard), print and sign the form below.

To:- The Manager (your Bank or Building Society)

Address



Postcode

Please pay to Lloyds Bank plc, Tunbridge Wells
Sort Code 30-98-77
Account name Old Skinners' Society
Account number 00171061

The sum of

Amount in words
Commencing date and annually thereafter until further notice
Quoting reference (please leave blank)

CANCEL ANY PREVIOUS AUTHORITY IN FAVOUR OF THE SOCIETY and debit my account accordingly.

Account to be debited
Name

Sort Code

Account number

Signed

Dated