Dept. P.P.
The Wildlife Trust West Wales
7 Market Street
Haverfordwest
Pembrokeshire SA61 1NF
WALES, Great Britain

INSTRUCTIONS TO YOUR BANK OR BUILDING SOCIETY TO PAY DIRECT DEBIT

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Originator's Ref
Originator's No. 98 20 97

To: The Manager

Bank:.................................................................

Bank Address:.........................................................

......................................................................

Name of Account:......................................................

Bank Account No.:.....................................................

Sort Code: ___ ___ - ___ ___ - ___ ___

I Instruct You to Pay Direct Debit from my account at the request of The Wildlife Trust West Wales.
The amounts are variable and may be debited on various dates.
I understand that The Wildlife Trust West Wales may change the amounts and dates only after giving me prior notice.
I will inform the Trust and the bank/building society in writing if I wish to cancel this instruction.
I understand that if any direct Debits paid break the terms of this instruction, the bank/building society will make a refund.

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

Thank you, from Percy and all of the Puffins!