Application for Membership.
Payment Details
Payment Type:
Standing Order
Direct Debit
To
:
Bank plc
Address
:
Please pay
Barclays Bank plc
High Street
Grays, Essex
Sort Code 20-34-69
for
OLD PALMERIANS' ASSOCIATION
account number
20997536
the sum of £5.00 (five pounds sterling)
NOW
and
ANNUALLY on 5th SEPTEMBER
until cancelled by me in writing.
Name:
A/C No.:
Signature:
Date: