To: …………………………………………………BANK / BUILDING SOCIETY

BRANCH NAME ……………………………………………………………

BRANCH POSTAL ADDRESS …………………………………………….

………………………………………………………………………………..

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POST CODE …………………………………………………………………

PLEASE PAY: NATIONAL WESTMINSTER BANK

St, Neots Branch

SORTING CODE: 60-18-23

FOR THE CREDIT OF: THE CLOVE CLUB

THE SUM OF: £10 (Ten Pounds Only)

Membership Number (to be quoted please) .............

COMMENCING: NOW and on the First Day of April …………….(Year)

ACCOUNT TO BE DEBITED (Please Print Name)

………………………………………………………….

ACCOUNT NUMBER ………………………………………………………….

DATE ……………………………. SIGNATURE …………………………………..

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