Bank Standing Order Form printable version

 


Yes, I want to give a regular gift to DWIB Leukaemia Trust

Bank Standing Order Form

Your details  
Title
First Name
Last Name
Address
Telephone/Mobile
Email
Your bank details  
To The Manager
(Bank name )
Bank Address
Account name
Account number
Sort code/ Branch
Your donation details  
I would like to donate ¢20,000 ¢100,000 ¢200,000 ¢500,000 Or
per month until futher notice.
Starting on
  (Please allow 28 days before your first donation)
I would prefer not to make a regular gift but please accept my donation

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