Standing Order Mandate Senior

 Standing Order Mandate – Senior Players

My Bank:                                  …………………………………………………………………………

My Bank's Postal Address:         …………………………………………………………………………

Please pay by banker's Standing Order, cancelling all previous instructions regarding this payee:

Pay To    -    (Bank):                  HSBC Bank, 221 High Street, Lincoln

Sort Code:                                 40-28-20

Account Number:                       72484617

Account Name:                          Senior Playing Members Lincoln RFC

Amount (Figures):                      £12.50 per month

Amount (Words):                                   Twelve Pounds, Fifty Pence per month

Date of First Payment:               1 September 2007

Payment due day or date:           First of each month or earliest thereafter

Frequency:                                Monthly until 31 August 2008 and please debit my account accordingly

Name of my account:                 …………………………………………………………………………..

Sort code:                                 …………………………………………………………………………..

Account number:                                   …………………………………………………………………………..

I hereby authorise you to set-up this standing order payment on my account:

Signed:                                     ......................................................................................................

Date:                                        ......................................................................................................

Name: (Block Capitals):              ......................................................................................................

Address:                                   …………………………………………………………………………..

Telephone:                                …………………………………………………………………………..