Your Bank.........................................Address.................................................................

Please Tick:           New Instruction............                

Please amend previous;   Standing Order.......

Quote Reference/beneficiary......................

Account to be Debited

Sort Code.............................................................

Account Number........................................................

Account Name............................................................

Beneficiary Details.

Barclays Bank Ltd, Framlingham.   Sort Code 20-98-07  A/C No. 60744689

Beneficiary Name  'Framlingham Swimming Club'

Payment Details

Amount of first payment. £..........................

Date of first Payment..................................

Amount of usual payment £......................

Amount in words..........................................

When Paid. (Monthly/Weekly/Annually.).....................

Date to be paid...............................

Date of last payment...............................

Continue until further notice...........................

Customer Signature................................................Date..............................................

Customer telephone number..............................................