Bankers Order Form
Please print this form and fill it in (BLOCK letters only please).
Please pay annually to HSBC Bank plc, 18 High Street,
REIGATE, RH2 9BB (branch code
40-38-10) the sum below to the
credit of The Reigate Society (account 706 905 38).
The sum to to be paid annually is £.............
Amount in words: .............
Date of first payment:
Subsequent payments to be made annually on the same date:
Branch code of my account to be debited:
Number of my account to be debited:
My name and address:
Please send the completed form to your bank, thank you.