Mortimer Community Benefit Society Share Application Form.

Mortimer Community Benefit Society Share Application Form.
If you wish to increase your shareholding, or to become a member of the Mortimer
Community Benefit Society by buying shares, please complete the form.
Name *

First Name Last Name
Address *

House name

Address Line 2

City

Postcode
Phone Number *

Area Code Phone Number
Email *
example@example.com
Number of Shares you wish to purchase. *
Total cost of the Shares you wish to purchase. *
PAYMENT

EITHER by cheque payable to The Mortimer CBS Limited sent to our address at c/o Yarpole Community Shop, Green Lane, Yarpole, Leominster, HR6 0BB.

OR by direct transfer to MCBS’s bank, using your initial and surname as reference.

BANK: Unity Trust Bank

Unity Current Account: Sort Code 60-83-01; Account Number 20447504

By applying to become a member of the Mortimer Community Benefit Society Ltd (MCBS) you agree to your name, address, phone number/s, email address where applicable and the number of shares you wish to purchase being held on a computer database. By signing this application form you are confirming that you
understand that this information will be used for the purpose of maintaining a register of members and potential members as required by the rules of MCBS and for posting of notices regarding the activities of MCBS. This information will not be passed to third parties. By signing below, you also confirm that you are over the age of 16 years.
I hereby apply for the number of shares referred to above as described in the Prospectus and in the Rules of The Mortimer CBS Limited
I have paid for my shares by the following means: *

BACS Transfer to the Unity Trust bank I have sent a cheque to the MCBS registered address.
Signature *

Clear
Date *

Month Day Year
Date
Please verify that you are human *
Should be Empty: