Jane Austen Society Midlands : Bankers Order

PLEASE COMPLETE IN BLOCK CAPITALS

To:

Name of Bank:

...........................................................................

Address of Bank:

...........................................................................

...........................................................................

...........................................................................

Postcode of Bank:

.........................

Sort Code:

...... - ...... - ......    Account No: .......................................

Please pay to The Jane Austen Midlands at Barclays Bank, Barclays Business Centre, PO Box 11, 22/23 High Street, Burton-on-Trent, Staffs. DE14 1AW, (Sort Code 20-15-96, Account No. 10521833) the sum of £.......... with immediate effect, and continue to pay this sum annually from
1 January 20...... until further orders in writing from me. Please debit my account for these payments.