Date: ______________
Name of Bank: _________________________________________________________
Address of Bank: _______________________________________________________
______________________________________________________________________
______________________________________________________________________
Post Code: _______________
Please pay on the _____ day of _______________ 20__ to Halifax (sort code 11-04-19),
to the credit of the account of CottonTails Charity, account number 00251601, the sum
of £ __________. and continue to pay the same annually/monthly* on the same
date/day* each year/month* until further notice. (*Please delete as appropriate)
Signed: __________________________________
Full name: ____________________________________________________________
Address: _____________________________________________________________
______________________________________________________________________
______________________________________________________________________
Post Code: _______________
Bank Account: ______________________________
Name on Account: _____________________________________________________
Account Number: ______________________________________________________