ESSEX & SOUTHEND SPORTS TRUST  STANDING ORDER MANDATE
Registered Charity no. 1092238

Section 1:  Details of Standing Order

Name of recipient

Essex and Southend Sports Trust

Bank name and address

Bank of Scotland Private Banking London West End
14-16 Cockspur Street, London SW1Y 5BL

Sort code number

12-01-03

Account number

00313524

Amount

£25 monthly*/£75 quarterly*/£300 annually*

*Delete as appropriate

Date of first payment

Date of last payment

Until further notice

Reference (for EASST use)

Section 2:  My account details

Name of account

Bank name and address

Sort code number

Account number

I authorise you to debit my/our account in accordance with the details in Section 1

Signature…………………………..  Date ………………..

Donor’s contact details

Address:

Tel no:           
E-mail:

Section 3:  Gift aid declaration

Please treat all donations I make to Essex and Southend Sports Trust from the date of this declaration until I notify you otherwise as Gift Aid donations

Signature: ………………………………….               Date: …………………………………