BANKERS ORDER

To: The Manager, …………………………………………………… Bank PLC

Address: …………………………………………………………
……………………………………………………………………………

Date: ...../.............../20.......

Please pay to Midland Bank PLC, 69 Pall Mall, London SWIY 5EY (Sort Code: 40-05-27) for the credit of "St Peter's Ealing Parochial Church Council Current Account" No: 11256548

The sum of: £ ..................(...........................................................)
note 1

On: ……………………………
note 2

and thereafter pay the same sum Monthly / Quarterly / Annually
note 3

until further notice, and debit my account with each payment when made.

This instruction is to replace any current standing order in favour of the above named beneficiary's accounts

Address: …………………………… Signature: …………………………………………

…………………………………………………………………………………………………

Name (block capitals)……………………………………

Bank Sort Code:…………………………

Account No: ………………………………

Account Name: ……………………………

Note 1 - Please insert payment in figures first, then in words in the brackets.
Note 2 - Please insert date of first payment -please allow time to transmit this instruction to your bank.
Note 3 - Please delete as appropriate

Please return this form, completed, to
Rosamund Rowe, Stewardship Recorder,
St Peter's Church Parish Office,
Mount Park Road,
Ealing,
LONDON W5 2RU

Please, do NOT return this form to YOUR bank.