BANKER'S ORDER FORM

On completion this form should be returned to the Membership Secretary (Mr R.M. Wynne Griffith, 1 Park Lane, Welshpool, Powys, SY21 7JN, United Kingdom), NOT to the Bank.

Banker's Standing Order - POWYSLAND CLUB

Registered Charity No. 510303

To the Manager . . . . . . . . . . . . . . . . . Bank PLC

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

Please pay on the First Day of January . . . . . . (year)

and on each First Day of January thereafter until further notice, to Lloyds Bank PLC, Welshpool (30-99-30) for the credit of

the Powysland Club Account number 0199073 the sum of £ 15 (or appropriate membership fee) quoting:

Full name (IN CAPITALS please) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Bank Account number . . . . . . . . . . . . . . . . . . . . . . . . .

Signed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

THIS SUPERSEDES ANY EXISTING INSTRUCTION TO PAY THE POWYSLAND CLUB