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
Account number
Your account details
My address:
(for cross referencing your donations)
Signed  
Date  

Please print this form, complete it and send it to us at Prostate Research Campaign UK,
10 Northfields Prospect, Putney Bridge Road, London, SW18 1PE.   Back from this page.