Standing Order Request

Please complete and hand it in to your bank

To (your banks name) _________________________________________________

Address ____________________________________________________________

____________________________________ Post code_______________

Account Name __________________________________

Sort code _________________ Account number ________________________

Full name ___________________________________________________________

Address ____________________________________________________________

____________________________________ Post code ______________________

Instruction to Bank

Please pay the sum of £ ______________________

Amount in words ____________________________________________________

Every Month / Quarter / Year (please specify)

Starting from/Date to commence payment ___________________ until further notice

Please pay to: Abbey, PO box 10122, 21 Prescott Street, London E1 8TN

For the credit of Kayshill Animal Sanctuary

Sort code 09-06-66 Account number 42531584

Payment reference to show on Abbey statement : _____________________

Signed __________________________________ Date ______________________