Standing Order Form

Fill in Standing Order Form

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1Bank Details

2Personal Details

3Confirm & Submit

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This order replaces any order currently in place for Bridgend Lifesavers Credit Union Ltd Members reference number quoted below.

To (Your Bank Name)*

Bank Address*

Street Address Address Line 2 City Post Code

Please Pay to: The Co-operative Bank Plc, 1 Balloon Street, Manchester, M60 4EP

Bank Sort Code	08 92 50	Account No.	67007130

BLSCU Ltd. Members Reference Number*

Membership Number and Surname must be included

The sum of*

Period*

Weekly

Fortnightly

Monthly

Commencing on:*

Until you receive notice from me in writing and debit my/our account accordingly.

Signatures (1)*

Signature (1) Date*

Signatures (2)*

Signature (2) Date*

Title (Name) of your Account*

Your Account Number*

Your Bank Sort Code*

BLSCU Ltd will send it to the bank on your behalf.

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Standing Order Form

Fill in Standing Order Form

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Standing Order Form

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