Standing order form

Date: …………..

To the Manager ..……………………………….… Bank

Bank’s address ………………………………………………………………..…………

…………………………………………………………………………………………

Please pay the sum of £…………………………………..…………… in words & figures

starting on ……………………. and thereafter every month on the …………day until

* I/we cancel these instructions * Delete if appropriate

* OR for a further 6 payments making seven payments in total * Delete if appropriate

Name of Account to be debited: ………………………………

Account number: ………………………………

Bank Sort Code: ………………………………

Account to be credited: Mustard Seed [Jersey] Sponsorship Account,

Red Houses, St. Brelade, Jersey.

Account number: 51143638 Bank Sort Code: 40-25-41

Signature/s: ………………………………………

……………………………………….

Please return to Adopt A Granny, Mustard Seed Jersey, Cardiff House, St Peter, Jersey JE3 7EJ