PAYING BY BANKERS ORDER

Please print and complete this form then send to the Membership Secretary

To (your bank):"  
Branch:  
Address:  
Postcode:  

Please pay the sum of £15 (fifteen pounds) for the credit of The Beresford Family Society Account No. 01642609 Giro Bank, Bootle Sort Code 72-00-05, quoting BFS No........... **, on the 1st day of ................... and then annually until further notice. (** Membership Secretary will add this number).

This cancels any other Bankers Order payable to the Beresford Family Society.

Account to be debited
Name :  
Number:  
Sort Code:  

Account holder
Name (block caps):  
Address  
   
Post Code:  
Signature:   Date: