Northern Counties Chihuahua Club

 

Yearly membership subscription Standing Order Request
 
PLEASE SUBMIT THIS TO YOUR OWN BANK AND NOT NCCC

 
Your Bank details

  Name of Bank           ______________________________________________

Bank Address           ______________________________________________
                                   ______________________________________________
                                   ______________________________________________


SORT CODE                         ______________________

ACCOUNT NUMBER           ______________________

NAME/ NAMES ON A/C      ______________________
 

I/We authorise you to debit the above account with the sum of (please tick)

     Single Membership for £3.00

     Joint Membership for £4.00

  On 1st January 2011 and yearly thereafter until further notice

 
Signed       ______________________________Date _______

 
Payable to

Northern Counties Chihuahua Club

Bank details               Royal Bank of Scotland
                                    Poulton-le-Fylde Branch
                                    1 Market Place
                                    Poulton-le-Fylde
                                    Lancashire
                                    FY6 7AT


Sort Code                  16-28-22
Account Number       10133548
Account Reference   CLUB SUBS (then surname and postcode/affix)