rollerski club - standing order form

Either use internet banking to set up your own regular payment to: Rollerski Instruction, A/C 61604937 Sort Code: 40-02-03 Or complete (print) the bankers order form:

To the Bank Manager (Name of Bank) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Branch Address. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Postcode . . . . . . . . . . . . . . . . .

Sort Code .........-.........-......... Account No. . . . . . . . . . . . . . . . . . . . .

Please pay Rollerski Instruction (rollerski club)

£ 20 / 30 every month (delete as applicable, £20 own equipment, £30 our equipment)

Start on ...../...../..... (date) until further notice.

Name (Mr/Ms/Mrs/Miss/Dr). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Signature . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Postcode. . . . . . . . . . . . . . . . . . . .

FOR BANK USE: Please use our ref: A/C 61604937 Sort Code: 40-02-03

Please cut out the completed Standing Order form and bring it along to a club session or send it to:

The Rollerski Co, 20 Brookfield, London N6 6AS