Standing order form

STANDING ORDER

To [name of bank] …………………………………………………..

http://address …………………………………………………… …………………………………………………………………..

Please pay Santander Bank, Bootle, sort code 09-01-51, for the credit of The Pink Triangle Trust, account number 82049302, the sum of [amount in figures] ………………………

[amount in words] …………………………………………………..

commencing [date of first payment] …………………………………………….. and thereafter every [due date or frequency] …………………………………………….. until further notice in writing or [date of last payment] ……………………………………. and debit my/our account accordingly.

This replaces any previous standing order I/we have made for transfer to the above account.

Name of account to be debited: ……………………………………….

Account number: …………………………………………………….

Name(s): ………………………………………………………….. [BLOCK CAPITALS PLEASE]

Address and postcode: ……………………………………………………………………………………

……………………………………………………………………………………………….

…………………………………………………………………..

Signature 1: …………………………………………………………

Signature 2: ………………………………………………………… [for joint accounts where both signatures are required]

Date: ……………………………………………………………..