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Organisation You Wish to Pay

Organisation Name:   Lauder Common Riding Patrons' Society

Bank Name and Address:  Bank of Scotland, Mid Row, Lauder TD2 6TB
   
Account Number:   06000455

Sort Code:    80 - 17 - 91

Reference:    ___________________________ (Patron's Name)

Payment Details

Amount of First Payment:  £__________ (£10 minimum)

Date of First Payment:  _____________________

Amount of Regular Payment: £__________ (£10 minimum)
   
Frequency:    Annually

Please continue payment until further notice

Account Holder Details

Account Name/s:   ______________________________________________________________________

Bank Name and Address:  _____________________________ ____________________________________
   
Account Number:   _____________________________

Sort Code:    _____________________________

Account Holder Signature/s:  __________________________________________________________

Date:     _____________________________