S.Y.E.S.S.R  CONFIRMATION OF STANDING ORDER

Please complete and return the relevant part(s) of this form and return to SYESSR C/O 4 Woodpecker Close, Aston, Sheffield, S26 2GD.

I request _______number(s) in your SYESSR Springer Ball Lottery and confirm  that I have sent a bank mandate form to my bank in order to set up a direct debit for the sum of _______ per month (or set up myself via online banking)

I wish to join your Special Supporter Scheme  and confirm  that I have sent a bank mandate form to my bank in order to set up a direct debit for the sum of ________ per month (or set up myself via online banking)

Name, Address & Telephone Number

Email Address

S.Y.E.S.S.R  BANK MANDATE FORM

STANDING ORDER MANDATE

Please complete and send this section to your bank (or set up yourself with online

banking)

Name of Bank

Bank Address

Post Code

PLEASE PAY: - South Yorkshire English Springer Spaniel Rescue

A/C No. 21192477 Sort Code 40-45-29

HSBC Plc

Wath-upon-Dearne Branch

Montgomery Road

Wath-upon-Dearne

Nr Rotherham

£_________on the __________________ and afterwards on the same day each month until further notice.

PLEASE MAKE THIS PAYMENT IN ADDITION TO ANY ALREADY MADE TO THIS CHARITY

Name of Account

Address

Post Code

Account Number

Signature

Date