STANDING ORDER MANDATE(PLEASE COMPLETE THIS FORM AND SEND IT DIRECTLY TO YOUR BANK WITHIN 7 DAYS) |
| YOUR BANK'S DETAILS | ||
| To: |
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Bank / Building Society |
| Branch: | ||
| Address: | ||
Post Code: |
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| BENEFICIARY'S DETAILS | |
| Please Pay: | CO-OPERATIVE BANK Skelmersdale Branch |
| Sort Code: | 08 - 92 - 99 |
| For the Credit of: | The Association for Person Centred Therapy Scotland (PCT Scotland) |
| Account No: | 65375796 |
| PAYMENT DETAILS | |
| The Sum of: | |
| Amount in Words: | |
| Commencing: | 19/02/2012 |
| And thereafter: | ANNUALLY from 1st June 2013 |
| Until: | You receive further notice in writing |
| Payment Reference: | |
| Further Instructions: | This order cancels any previous order in favour of The Association for Person Centred Therapy Scotland (PCT Scotland) |
| ACCOUNT TO BE DEBITED (YOUR ACCOUNT DETAILS) | |
| Name of Account: | |
| Sort Code: | – – |
| Account No: | |
Signature(s) ................................................. Date .........................