Direct Debit Form

Warwickshire Wildlife Trust Direct Debit Form

Please complete this form, then print it off and sign it, to instruct your bank or building society to make payments from your account.

Originator's Identification Number

Name and full address of your bank or building society:

To the Manager,
Bank/Building Society:
Address 1:
Address 2: Post Code

Name and address of Account Holder:

Name:
Address 1:
Address 2: Post Code

Bank/building society account number:

Branch sort code:

(Our Office Use - Reference Number)

Instructions to your bank or building society:

Please pay Warwickshire Wildlife Trust Direct Debits from the account in this instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with Warwickshire Wildlife Trust and, if so, details will be passed electronically to my bank/building society.

Signature:_______________________________ Date:___________________

When you have completed this form, please print it, sign it, then return it to us together with your membership form:

Warwickshire Wildlife Trust, Brandon Marsh Nature Centre,
Brandon Lane, Coventry CV3 3GW.

Telephone: 024 7630 2912 Registered Charity Number 209200 Thank you again for your support!

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