If you prefer to pay by Banker's Standing Order, please print out this page, fill it in and mail it with your Application Form.
| to | ________________________________ Bank |
| ________________________________ Branch | |
| address | ________________________________________ ________________________________________ ________________________________________ ________________________________________ |
On receipt of this order and on the first day of January each year thereafter until further notice, please pay to HSBC Bank PLC, Dorking Branch, 67 West Street, Dorking, Surrey, RH4 1BW for the credit of The Dorking & District Chamber of Commerce (a/c no: 81269941, sort code 40-19-22) the sum of £ ______
This instruction cancels any previous order in favour of the above beneficiary.
| Name | ________________________________ |
| Account number | ________________________________ |
| Date | ________________________________ |
| Signature | ________________________________ |
