Standing Order Form

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1Bank Details

2Personal Details

3Confirm & Submit

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)*
Date*
Signatures (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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