New Standing Order Instruction

To…………………………………………………………………Bank

Please set up the following Standing Order and debit my/our account accordingly.

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Account Details

Account Name:                                                           

Account Number:

Sort Code:

Account Holding Branch:                        

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Payee Details

 

Organisation:                AMBULANCE SERVICES BENEVOLENT FUND

 

Sort Code:                   20 – 76 - 89     

 

Account number:            30742406

 

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About the Payment

 

How often are the payments to be made i.e. monthly, quarterly, half yearly. Please state………………………………………………………..

 

Amount Details

 

Date & amount of first payment:        /       /200         £

 

Date & amount of ongoing payments (if different from the first payment)

 

Date and amount:                                   /       /200         £     

 

Date of final payment:                      /       /200 or until further notice

 

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Confirmation

 

Customers signature(s)

 

 

 

 

Date:

 

Ambulance Services Benevolent Fund. Registered Charity No: 800434.