Focal 100 Club Membership Form and Bank Mandate
Focal 100 Club Sign-Up
Membership number: (leave blank)
(to whom cheque should be made out for winnings)
‘Phone no: Mobile:
I/we understand that Focal will forward the completed Standing Order Mandate to the bank indicated and that £2.00 will be taken from my/our account on the first business day of each month or a sum of £24.00 to be paid annually by cheque or standing order into the Focal account until I/we advise the bank otherwise.
I/we agree that, if we wish to cancel this Standing Order, I/we will also inform Focal of this decision.
Please return this form to Stuart Phipps, 12 Walton Avenue, Twyford, Banbury, Oxfordshire, OX17 4LB or Email: Stuart.Phipps@live.co.uk together with your Standing Order Mandate/cheque so we can update our records.
Thank you for your support and good luck!
STANDING ORDER MANDATE
Sort Code: – – Account Number:
Account name: Friends of the Community of Adderbury Library
Bank: Lloyds Bank plc, 14 High Street, Banbury, Oxon OX16 5EF
Sort Code: 30-90-42 Account Number: 07291653
Date of first regular payment:
Amount and frequency thereafter (select one of these):
£2.00 monthly £24.00 annually
Payment reference: (Initial & surname)
Until further notice in writing.
〈 〉 Please tick if you are a UK tax payer and wish Focal to claim Gift Aid on your payments