STANDING ORDER

Please complete this form in BLOCK CAPITALS and take or send it to your bank.

To Bank /Building Society

Branch

Account Number __ __ __ __ __ __ __ __ Sort Code __ __- __ __ -__ __

Cancel any previous Standing Order to Beverley Athletic Club.

Set up the following Standing Order and debit my/our account accordingly: -

Please pay the sum of £15 on 1^st May 2009 or immediately if after that date.

Then £15 every year on 1^st May until further notice.

To, NATIONAL WESTMINSTER BANK PLC, for the credit of Beverley Athletic Club

Account number 9 9 1 7 4 3 4 0 Sort code 6 0 – 0 2 – 2 3

Name

Address

Post Code

Date / /

Signature