RPM Standing Order Form

To................................................................................

bank {name of bank}..................................................

Address of bank

...................................................................................................................

...................................................................................................................

Please pay Girobank PLC, Bootle, Merseyside GIR OAA; sorting code 72-00-00
For the credit of the RPM account 47 216 1288

The sum of ..................................

Amount in words.........................................................

Commencing..............................................................

{and thereafter every month}

Account to be debited {e.g. current, etc}.......................

Account No............................................

Signatures {s}

................................................................................

Name....................................................

Address

...............................................................................................................................