As the bank needs your original signature, we need you to print off and sign the paper copy and send it to us.
Your name�����������������������.�..���������.
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Please send to Orpington Liberal Democrats, 7 Station Road, Orpington, BR6 0RZ in an envelope marked �200 Club�. Thank you.
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Standing Order Authority
To ���������������������������������..���.
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[insert the name and postal address of your bank]
Your Account Details
sort code ....................................................
account number...........................................
Your account name:������������������������.�
Account To Be Credited: Orpington Liberal 200 Club
National Westminster Bank Plc, 235 High Street, Orpington
Sort Code: 60 16 03 Account number: 14121484
Please pay �................. [amount in figures] ......................................... [amount in words]
annually*
On �������. [date] and six monthly* thereafter until further notice:-
Signature��������������������� Date������.�..
*delete as necessary