STANDING ORDER FORM

Please print, fill in, sign and return to us by post. We will process the form and send it on to your Bank.

Your Name....................................................................................................................... .

Organisation ....................................................................................................................

Address..............................................................................................................................

Tel................................................................email.............................................................

I wish to pay by standing order the sum of £15 : £25 : £50 : £100 immediately and annually thereafter, or until I cancel it to Barclays Bank, Sort code 20-96-89, for the account of Wimbldeon Civic Forum, Account number 20438375 being my annual subscription to the Wimbledon Civic Forum. Please cancel any other standing orders in favour of WCF.

Signed .............................................................................................................................

Date ............................................................

SEND TO:

My bank / building society ............................................................................................

Address ..........................................................................................................................

..........................................................................................................................................

Bank Sort Code ........................................... My account number .............................

My account name ....................................