LTS - Standing order mandate

Standing order mandate

To: .............................................................. ..............................................................

Bank:

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

Address:

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

Please pay to Alliance & Leicester plc, Bootle branch, sorting code 72-00-05, for the credit of London Topographical Society account no. 70771900 quoting reference ..............................* the sum of £18 (eighteen pounds) on

....................................... (date of first payment) and annually thereafter on 1st January until further notice in writing and debit my/our account accordingly. Please cancel all previous standing order mandates in favour of London Topographical Society.

Holder of the account to be debited:

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

Account no.:

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

Signature(s):

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

Date:

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

* Please return this form to the Society for the insertion of the reference.