My INSTRUCTIONS: Please Debit my account in accordance with the following:
Payee: WHITSTABLE RUGBY CLUB
ACCOUNT No: 00407065
SORT CODE : 30-99-61
BANK : Lloyds Bank
ADDRESS: 14 High Street
Whitstable
Kent
CT5 1BH

AMOUNT (multiples of £2.50): £
AMOUNT IN WORDS:

FIRST PAYMENT and FREQUENCY: 1st...........201... and 1st day of each month thereafter until further notice.

MY REFERENCE:

TERMS: This debit instruction should continue to run with my account debited on the month denoted until such time as you receive a written cancellation notice from me.

ACCOUNT HOLDER DETAILS:

NAME:

ACCOUNT NUMBER:

SORT CODE:

MY ADDRESS:

SIGNATURE:

DATE:

On completion please return this form to :
Jamie Kemp
The Hollies
Otterden Road
Eastling
Faversham
Kent
ME13 0BW