(click theprint button on your browser to print this form)
Bankers Order Mandate

Bank Name………………………………………

Bank Address…………………………………......Bank Sort Code ........................

Please Pay BANK OF SCOTLAND, HIGH STREET. DUMFRIES
For the credit of Dumfries and Galloway Fine Arts Society
Sort Code 80-11-60 Account No. 00269854

The sum of £10.00 ( Ten pounds only ) commencing 1st January 2011 and thereafter annually until further notice.
Replace any existing standing order to Dumfries & Galloway Fine Arts Society

Account to be debited…………………………………………………………

Account Number……………………

Signed………………………........................Date……………………………

Following completion of the form as appropriate,
please send it to the Secretary.