Neath R.F.C. Lottery Application Form

Maltese Cross

Please print out and return completed form to:
The Lottery Promoter,
The Courage Gnoll,
Gnoll Park Road,
Neath, SA11 3BU
Mr. Mrs. Ms.
       
TELEPHONE NO
                           
Surname
                           
Initials
     
Address
                                     
Preferred Method of Payment
 
                                     
£48 Annual + free month
 
£4 month S/order
 


Bank Details

To (Bank Address)

 
 
 
 
 
STANDING ORDER AUTHORITY
Please initiate the following standing order payment
AMOUNT: FOUR POUNDS (£4)
FREQUENCY: MONTHLY
BENEFICIARY BANK: TSB BANK PLC
BENEFICIARY NAME: NEATH RFC LOTTERY
BENEFICIARY SORT CODE A/C: 30 95 86
2155726
Account No.
               
Allocated Lottery Number - for official use only
       
REMITTERS NAME
                                                         
REMITTERS ADDRESS
                                                         
First payment - 1st of ____________ and monthly thereafter.
Date ____/____/________ Signature ____________________