Fill out this form if you wish to make a regular payment by standing order. Print it and post it only accompanied by the donation form. Post it to Voluntary Help Centre, Stella Peskett Millennium Hall, Mights Road, Southwold, Suffolk, IP18 6BE

Voluntary Help Centre

BANKERS' ORDER

To:

Name and address of your bank

Account to be debited:

Account number

Please pay to Southwold VHC the sum of £ select

Starting date until further notice

Payable to Lloyds TSB, 17 Market Place, Southwold IP18 6

Sort Code: 30-13-64

Account No: 0466690

Beneficiary: Southwold VHC

This cancels any previous Standing Order to Suthwold VHC

Signed: ............................................................................... (Please remember to sign after you have printed this form)

Date

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