Andover/Abbot Association of London 

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Standing Order Mandate (print this form, sign it and give it to your bank)

To: _______________________________________  Bank

Branch Address:              ___________________________

                                        ___________________________

                                        ___________________________

Account Holder's Name:  _______________________

Sort Code: ______ - ______ - ______

Please set up the following standing order and debit my account accordingly:

Payee: Andover/Abott Association of London

Bank:

National Westminster Bank

Sloane Square Branch

PO Box 3041

34 Sloane Square

London SW1W 8AZ

Account Number: 89013522   Sort Code: 60-19-26

Amount of Payment: £10 (ten pounds sterling only)

First payment: immediately, upon receipt of this order

Subsequent payments: annually on 1 July

Signature ________________________________   Date ________________

Member name (please print) _______________________________________