Please enter me in the W.R.F.C. "6 UP CLUB"

My numbers are:

 I agree to pay by Standing order; 12 monthly payments of £4 with 4 free weeks

 Name: ……………………...…………….      Tel: …………………………

Email:………………………………………………………………………...

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Standing Order Form

To: .…………………………………………………Bank,        Sort Code:……………....

Branch address:…………..…………………………………………………………….

Account name: ……………………………………………………………………        

Account no: ……………………………………

Please set up the following standing order and debit my account accordingly.

Payee: Wellingborough Rugby Football Club

Bank and Branch Name: National Westminster Bank PLC, Wellingborough

Account no: 96812559                        Sort Code: 55-70-37               Reference:

Amount: £4 (Four pounds only)

Frequency: On the 1st monthly, until further notice.

Commencing on the 1^st …………………… 200…

Customer’s Signature:…………………………………………………………………………….                     

Date: …………………………….