DONATE

STANDING ORDER

Please print and return this form to:

The Anita Goulden Trust, PO Box 77029, London, SW6 9PT who will record details and forward it to your bank.

To the Manager

Bank:

Address:

Postcode:

Account Number:

Date:

Please pay: Coutts & Co, St. Martin’s, Sorting Code Number: 180002 for the credit of: Anita Goulden Trust, Account Number: 00400020 the sum £………and thereafter on the same day monthly/quarterly/annually* until you receive further notice from me/us* in writing.

*Delete as applicable.

Commencing (date of first payment):

Please note: This Instruction cancels any previous order in favour of the above named beneficiary.

Name:

Address:

Postcode:

Signature/s: