Focal 100 Club Membership Form and Bank Mandate

Focal 100 Club Sign-Up

Membership number: (leave blank)


Name:


(to whom cheque should be made out for winnings)

‘Phone no:                                           Mobile:


Postal address:


 


Post Code:


E-mail address:


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.

Signature                                                  Date


Please return this form to Adderbury Library, together with your Standing Order Mandate/cheque so we can update our records.

Thank you for your support and good luck!

 

STANDING ORDER MANDATE

YOUR DETAILS:

Full name:


Address:


 


Post Code:


Bank name:


Bank address:


 


Post Code:


Sort Code:      –      –                Account Number:


PLEASE PAY:

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

Signature                                                          Date