BonaGrass Grove Ladies Hockey Club

To…………………………………………………..(Name and address of your Bank)

....................................................................................

………………………………………………………

Please pay the undernoted Standing Order to:

Bank of Scotland

Marketgait, Dundee

Sort Code: 80-73-31

Account Name: Bonagrass Grove LHC

Account Number: 00165982

Please pay the following:

Amount £………        

Commencing 1^st October 200  and the following seven months 1^st monthly the last payment being on

1^st  May 200

To be debited from my Account:

Account Name………………………..

Account Number……………………..

Signature…………………………………….

Date……………………