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              £12.00 (Twelve Pounds Sterling Only)

 

   Date of First Payment: 3rd January 2009 or Immediately if after 03/01/09

   Frequency:   Annually 3rd 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:……………………. 

                                                 

     ………………………………………………………

 

………………………………………………………