Chaldon Animal

Sanctuary

Standing Order Authority

Name of your Bank...................................................... Branch Title.....................................................

Address of your Bank............................................................................................................................

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

                                       .................................................................. Post Code....................................

Your Account No.................................................................            Sort Code......................................

Please pay the sum of £.............. from the above account on the .............. day of each month / quarter / year  commencing ................................................. to: BARCLAYS BANK, 10 The Square, Caterham, Surrey. CR3 6XH  for the credit of CHALDON ANIMAL SANCTUARY.

ACCOUNT NO. 30497797 / SORT CODE NO. 20-24-64.

Name........................................................................................................................................................

Address...................................................................................................................................................

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

              ............................................................................   Post Code..................................................

Signature(s)............................................................................................................................................

Print Name(s)......................................................                       ............................................................

Date.....................................................

(Please send this form to your Bank/Building Society and let us know that you have set this up)

Thank you - Your support is greatly appreciated!