Welcome to DABAL

Please complete the

STANDING ORDER MANDATE/PERSONAL DONATION FORM

in BLOCK CAPITALS

STANDING ORDER MANDATE

Name and full postal address of your bank/building society:

Account number:

Sort Code:

Name of account holder :

Recipient Name:

Recipient account number:

Recipient bank:

Recipient sort code:

Payment amount :

First payment date:

Payment frequency:

Instruction to bank

Please set up the above standing order and debit my/ our account until further notice

Date:

Personal Donation :

I wish to donate a sum of £ :

Name:

Tel no:

Address:

Are you Taxpayer?

Yes

Date