Please complete and send to your bank branch: -

    The Manager: ……………………………………………

     Branch Postal Address:.…………………………………...

   ………………………………………………………………

   Please pay by Banker's Standing Order, cancelling any previous instructions regarding this payee:

   Pay To:    Lloyds TSB Bank plc. Ellesmere Port Branch

   Sort Code:   30-12-96                           

    Account Number:  01295795

   Account Name:  Countess Owners Association

   Reference (boat name)           ………………………………..

    Amount              £17.00 (Seventeen Pounds Sterling Only)

   Date of First Payment: 1st January 2012 or Immediately if after 01/01/12

   Frequency:   Annually 1st January              Until further notice and debit my account accordingly: -

   Name of my account:…………………………………….

   Sort code:……………………Account number:…………………………………

   I hereby authorise you to set-up this standing order payment on my account:

   Signed:......................................................…………...Date:...............................….

   Name: (Block Capitals):................................................................................……..

   Address:…………………………………………..Telephone:……………………. 

     ………………………………………………………

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