Bankers Order Form

Please print this form and fill it in (BLOCK letters only please).


Bank Name:

Address:



Post Code:


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:







Signature:



Please send the completed form to your bank, thank you.