| Bank Standing Order | ||
| To: The Manager, | ||
| Name of Bank/Building Society Your bank or building society details |
||
| Address | ||
| Post code | ||
| Please pay to: Your instructions |
Prostate Research Campaign UK Allied Irish Bank (GB) Sort code 23-84-82 Account No. 41087068 |
|
| The sum of: | ||
| Amount in words: | ||
| Every: (Tick appropriate box) | Month Quarter Year | |
| Starting on: (Please choose a start date at least one month from now) | / / (dd/mm/yy) | |
| From my Account - Name Your account details |
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| Account number | ||
| Signed | ||
| Date | ||
Please print
this form, sign it and send it to us at Prostate Research
Campaign UK,
10 Northfields Prospect, Putney Bridge Road, London, SW18 1PE. Back from this page.