Standing Order Mandate Form

To my bank:

Postal address:

Please pay by banker’s standing order, cancelling any previous instructions regarding this payee:

To (Bank):

Sort Code:

Account Number:

Name of Account:

Amount (Figures): £

Amount (Words):

Date of First Payment:

Payment Due Date:

Frequency:

Until further notice and debit my account:

Name of my account:

My account number:

Sort Code:

I hereby authorise you to set-up this standing order payment on my account:

Signed: ……………………………

Date: ……………………………

Name (Block Capitals): ……………………………

Address:

……………………………

Telephone:

……………………………