Unity of purpose over conflict and discord

Standing Order Mandate

(Please complete and take to your bank) My bank: My bank's postal address:

Please pay by banker's standing order, cancelling any previous instructions regarding this payee . Pay to (Bank): HSBC, 85 Holton Road, Barry, CF63 4HG Sort code: 4009-15 Account number: 61537938

Account name: Barry Town Supporters Committee Amount (Figures): Amount (Words): Date of first payment: Payment due day or date: Frequency:

Until further notice and debit my account accordingly: Name of my account: Sort code: Account number:

I hereby authorise you to set-up this standing order payment on my account. Signed: Name (block capitals): Address: Date: Telephone:

BTSC

Barry Town Supporters Committee (Company No. 06796885) Clifton House, Four Elms Road, Cardiff, CF24 1LE. www.barrytown.co.cc