Please print, complete and then forward to your bank/building society

 

Name of Charity CANCER CAMPAIGN IN SUFFOLK
Registered Charity No: 1073241
Inland Revenue Ref: XR 30687

 

To the Manager

Bank

Address

 

 

Please Pay Cancer Campaign in Suffolk
Bank: Barclays Bank, Princes Street, Ipswich, Suffolk
Account No: 50868795
Sort Code: 20-44-51

 The Sum of: 

 £
Amount in Words

 

 

On .................................................. (insert date) and the same amount monthly/annually (please delete as appropriate) until further notice.

This instruction cancels any previous order in favour of the beneficiary named above.

Debited account name to be quoted as the transaction reference.

Details of account to be debited are as follows:

Account Name

                                                                    

Account Number: 

  

Sort Code: 

  

Name:

 

  

Address:

  

  

 

Signature

 

 

Date

 

 Cancer Campaign in Suffolk, 39-41 Elm Street Ipswich IP1 2AB

Telephone No: 01473 211884

Web Address: www.cancercampaigninsuffolk.co.uk

Registered Charity No: 1073241