STANDING ORDER FORM

If you would like to make a charitable donation to Dumfries Welfare Rights, please print out this form and post it to us.

Title

Forename

Surname

Address (1)

Address (2)

Postcode

Telephone

E-mail address

BANK / BUILDING SOCIETY DETAILS

To the Manager

Bank / Building Society: Name

Address (1)

Address (2)

Postcode

Sort Code

Your account number

Please pay Dumfries Welfare Rights the sum of

£ ---------------------------------

Every: Month ٱ Quarter ٱ Year ٱ

(Please tick as appropriate) Until further notice.

Starting on (Date) -------------------------------------

Your Signature ------------------------------------- Today’s Date ------------------------------------

THANK YOU: Please return to:

Dumfries Welfare Rights:

Dumfries Welfare Rights

50 Lincluden Rd

Dumfries

DG2 OQB

Tel: 01387 - 266888