Friends of Hautbois application form

Standing order mandate
To the manager
Name of Bank
Bank address

Street Address

Street Address Line 2

CityState / Province

Postal code
Please pay - Lloyds Bank plc, 16 Gentlemans Walk Norwich, NR2 1LZ
For the credit of - Guide Association Anglia Region, Sort code - 30-96-17, Account Number 01735700
Please quote reference FoH and either your name or Friends' membership number
Please choose one of the following payment options:
Please choose one of the following payment options:
The sum of (in words) e.g twenty* , pounds ( £ e.g 20* ). On the (date), e.g 28th* (month), e.g February* (year), e.g. 2025* and thereafter every year until further notice and debit my account accordingly.
Name of account holder to be debited

First NameLast Name
Account number
Sort code
Sign
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate of signature
Your name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal code
Telephone Number
Format: +44 0000000000.
Email
example@example.com

Individual subscription	£10.00 per year
Group subscription	£20.00 per year

Standing order mandate