Friends of West Hatch Lottery

PRINTABLE APPLICATION FORM

THANK YOU - WE REALLY APPRECIATE YOUR SUPPORT

NAME:  ..............................................................(Print) TELEPHONE :   ................................

ADDRESS: ...........................................................................................................................

POSTCODE: ........................................  EMAIL ADDRESS  .......................................@.......................................

NAME & ADDRESS OF BANK: ..........................................................................................

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

ACCOUNT NUMBER: ...........................................  SORT CODE: ................................

(I am over 16 years old or over.)

Please pay The Friends of West Hatch £5.00 per month by Standing Order

commencing ...........................................     until further notice

SIGNED ........................................................     DATE: ........................................

RSPCA - FRIENDS OF WEST HATCH BANK DETAILS

NATWEST BANK TAUNTON  Account Number  59569360  Sort Code 60 – 80 - 06

Please return completed form to :

Friends of West Hatch Lottery Co-ordinator,

8, Chestnut Avenue, Worle, Weston-super-Mare BS22 6RQ