| To |
_________________________ Bank Plc (Please insert bank name) |
| Sort code |
____-____-____ (Insert your branch sort code) |
| Branch |
_________________________ (Insert your branch name) |
| Please pay to |
Lloyds TSB Bank Plc |
| Branch |
Tyne Valley |
| Sort code |
30-19-54 |
| For the credit of |
B.H.S.C. |
| Account number |
07668679 |
| The sum of |
£12 (twelve pounds) |
| On |
1st November annually |
| Until |
Further notice |
| Quoting reference |
MEM |
| Account name to be debited |
_________________________ (Please insert name of account) |
| Account number |
_________________________ (Please insert account number) |
Please attach a cheque for £12 for your first year's subscription and then send it with this form to:
The Secretary
Black Horse Ski Club
2A Langford Crescent
Benfleet
Essex
SS7 3JP
