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

My numbers are:

·        I would like to pay by Standing order (12 monthly payments of £4 with 4 free weeks)

• I Would like to pay £1 a week to a collector (or £4 a month)

(delete as appropriate)

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

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Standing Order Form (where appropriate)

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: ………………………