Address of your Bank .............................................................................................................................

......................................................................................................... Post Code ...................................

Your Account No. ............................................................... Sort Code .............................

Please pay the sum of £.......... from the above account on the .......... day of each month / quarter / year

commencing ......................................... to: BARCLAYS BANK, 10 The Square, Caterham, Surrey CR3 6XH
for the credit of CHALDON ANIMAL SANCTUARY.
ACCOUNT NO. 30497797 / SORT CODE NO. 20-24-64.

Name..................................................................................................................................................................................

Address..............................................................................................................................................................................

..................................................................................................... Post Code .....................................

Signature(s) ...................................................... / ...................................................

Date ..............................................

(Please send this form to your Bank/Building Society and let us know that you have set this up - Thank you!)