(Registered Charity No. 1084279)

BANKER'S ORDER FORM

To: (your bank)_______________________________________________________

Address_____________________________________________________________

____________________________________________________________________

Postcode____________________________________________________________

Please pay to the SUFFOLK RECORDS SOCIETY CHARTERS SERIES (Account No 00006831) at CafCash Ltd, Kings' Hill, West Malling, Kent (Code 40-52-40) the sum of £10.00 (Ten pounds) on the 

___________day of__________________________20_____________________

and thereafter on the 1st of May in each succeeding year until further notice, and debit my/our account accordingly.

This order cancels any previous order in favour of the beneficiary above payable to this account number.

Name (in capitals)_____________________________________________________

Address_____________________________________________________________

____________________________________________________________________

____________________________________________________________________

Postcode____________________________________________________________

My account number___________________________________________________

Signed_____________________________________Date_____________________

 

This completed form should be returned to Hon Secretary, Claire Barker MA, Westhorpe Lodge, Westhorpe, Stowmarket, IP14 4TA.