STANDING ORDER FORM

Your name: Mr/Mrs/Miss/Ms-------------------------------------------

Address------------------------------------------------------------------------

----------------------------------------------Postcode-------------------------

To Manager (name of your bank)--------------------------------------

Address (of your bank)----------------------------------------------------

----------------------------------------------------------------------------------

--------------------------------------------------Postcode---------------------

Please pay ACTION FOR ANIMALS the sum of £---------------

each month until further notice and debit my account number
 
 --------------------------------------------------------------------

Branch sort code -----------------------------------------------------------

Starting on (date)------------------------- and each month thereafter.

(Please allow at least one month before signing this form and the date of the
first payment.)
  
Please return to Action For Animals and not to your bank.
Action for Animals, P.O. Box 986, Southamton, SO19 5TR

Signature----------------------------------------------------------------------

NB you must notify your bank if you wish to cancel a previous Standing Order.

For bank use only.

Please pay to:

ACTION FOR ANIMALS, 81152041,

Bank Sort Code 40-05-09, Midland Bank, Notting Hill Gate, London W11 3JJ
 
    Thank you

Registered charity no. 1068487. Form:web2