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The form below is for one payment of £25 per year. For payment in two instalments click here


BANKERS ORDER


Please pay to the account of the MONUMENTAL BRASS SOCIETY at Barclays Bank PLC at Barclays Business Centre, Holborn and Chancery Lane Branch, 147 Holborn, London EC1N 2NU; Sort code 20-41-41; Account no. 10660957

the sum of £ 

(in words )


IMMEDIATELY / NEXT 1st JANUARY (see note below) and the same sum EACH YEAR ON 1st JANUARY until further notice. 


This instruction cancels any previous order in favour of the Monumental Brass Society.




Name of bank 

Branch 

Sort code 

              -              -

Name of account to be debited

Account number 


Signature 



..............................................................


Date

Note: For applications made between 1st January and 30th September, delete NEXT 1st JANUARY; for other applications delete IMMEDIATELY.

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Copyright © 2002 Monumental Brass Society (MBS)

Page last updated 01 July 2009