Standing Order Mandate

IN BLOCK CAPITALS

Please pay the undernoted Standing order with effect from 01/01/2----

Please pay the Standing Order to :- (Beneficiary Details)

Bank : Bank of Scotland Sort Code 80 – 02 – 33

Branch Address : 5 Montagu Terrace, Edinburgh, EH3 5QX

Account Name : George Heriot’s F.P. Golf Club

Account Number : 00403966

Reference No :

Please pay the following :- (Payment Details)

Amount : £20 In words : Twenty pounds

Commencing : 01/01/2------ Due date & frequency : Annually

Last Payment : until further notice

To be debited from my account :- (Remitters Details)

Special Instructions Please cancel all previous Standing Order and / or Direct Debit Mandates under Reference No

Banks may decline to accept instructions to charge Standing Orders to certain types of accounts other than current accounts.