Bank standing order mandate

To the Manager of

From

Please pay an amount of: £...............

to the account of the "Makaton Vocabulary Development Project" at Lloyds Bank Plc, 19 -23 Obelisk Way, Camberley, Surrey, GU15 3SE (sort code: 30 - 91- 53, account number: 3084672), quoting my surname.

The payments should commence on (date):......................

or immediately upon receipt of this order, whichever is the latest date, and thereafter monthly/quarterly/annually # on the above day.

Please deduct these sums from:

Signature ..........................................................

Date ..........................................

# delete as applicable