Payment by Bankers Order
Block capitals, please
To: (Your Bank) _____________________________________________
Address ___________________________________________________
____________________________________________________
_____________________________________________________
Post Code _____________________
Please pay to:
Lloyds TSB Bank plc, Bath Branch, 47 Milsom Street, Bath. BA1 1DN
Sort Code 30-90-54 for Account No. 00142900 of the William Herschel Society
And the sum of £______________ on _______day _________month 20____
And the same sum on the same day each year until further notice.
Debit A/C No. ______________________________
Signature __________________________________
Date _______________________
Title ______________
Forename(s) _______________________________________________
Surname __________________________________________________
Address ___________________________________________________
____________________________________________________
Post Code __________________
Please send completed form to the Membership Secretary, not to your Bank.
Herschel House, 19 New King Street, Bath. BA1 2BL UK. Tel:+44(0)1225 446865