To: The Manager:

Branch Address:

Sort Code:

Account No:

Pay to:

Account no:

Bank sort code:

The sum of:

Date of first payment:

Date of regular payment:

Frequency:

Final payment date:

Please pay to Friends of TREAD (details above) by Standing Order from my bank account.
I understand that this instruction may remain with Friends of TREAD and if so details
will be passed electronically to my Bank / Building Society.

Signed:

Date: