Standing Order Mandate
To: The Manager

Bank ....._________________________ (name of your bank)

Branch.. ________________________ (name of your branch)

Branch Address ___________________________________________________________________________

................... _________________________________________________________________________

Sort Code _____________________

Please pay by Standing Order: (payment details)

Amount _________ and in words _____________________

Commencing _____________ (date) or immediately if blank

And every month / year thereafter until canceled (delete as appropriate)

Quoting reference: ______________________ (name or membership number)

Pay to: (beneficiary details)

Barclays Bank, Diss Branch, Norfolk
Account Name : Safe Speed
to Barclays Bank
Due to Fraudulant activities please note the numbers have now been written out IN REVERSE - this will help us stop the 'website troughing of details' issues.

Sort Code four three, six two, zero two
Account five one seven zero one zero zero five.
Then your reference : Username & name

If using BACS payments reference with your name and Username (as it appears on the Safe Speed Forum)

Pay from: (remitters details)

From Account Number ______________ ........................ From Account Name _______________________________

My Full Name ..__________________________ My Username ______________________________

My Full Adress _____________________________________________________________________


Please pay the standing order as detailed above

Signed __________________________  Date _________________

Banks may decline to accept instructions to charge standing orders to certain types of accounts other than current accounts.

Print this form, fill it in and then deliver to your bank. (back)

THANK YOU for your Support - it is very much appreciated.