The Derbyshire Ornithological Society


STANDING ORDER MANDATE
 BANKERS ORDER
to:
The Manager

__________________________________________ (Name and Address of your bank)

__________________________________________

__________________________________________

__________________________________________

_________________ (Post Code)

WITH RESPECT to: My/Our
ACCOUNT NAME: ________________________________
ACCOUNT NUMBER: ______________________________
SORT CODE: ___-___-___

Please pay annually on the first day of January beginning on_1st January 20___

The sum of £_____
to:
NATIONAL WESTMINSTER BANK plc,
PO Box 283,
58 St Peter's Street,
DERBY DE1 9DT
Sort Code 01-02-66
Account Number 90023781

For the credit of the DERBYSHIRE ORNITHOLOGICAL SOCIETY

Signature(s): ________________________________

Date: ________________

Please send this completed form to the DOS Treasurer, B Staley, 20 Lancelot Drive, Stretton, Burton-on-Trent, Staffs, DE13 0GJ

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