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EUROPEAN MOVEMENT
STANDING ORDER MANDATE
Please complete this form and return it to:- Administration, The European Movement, PO
Box P0032, 265-269 Kingston Road, Wimbledon, London SW19 3FW
Once we have received the completed form we will keep a photocopy and send the original
standing order form to your bank so that they can process payments.
Your details:
Name:
_________________________________________________________________________
Address:
_________________________________________________________________________
____________________________________________________________
Postcode: __________________
Telephone: _________________________
E-mail: _____________________________________
Annually I would like to pay (Please tick):
[ ] £25 (member: single)
[ ] £10 (youth: waged)
[ ] £35 (member: couple) [ ] £5 (youth: unwaged)
[ ] £12 single member concessional
OR: I would like to make a monthly payment of £ _____________
Instructions to your Bank or Building Society to pay by Standing Order. To:
Bank Name:
_________________________________________________________________________
Bank Address:
_________________________________________________________________________
____________________________________________ Postcode:
___________________________________
Account name: _________________________
Account number: __________________________ Sort code: __________________
Please pay the sum of £ __________ on the ________ day of _____________ (month)
_________ (year)
And on the same day of each succeeding month/quarter/year (please delete as appropriate)
until further notice to:
HSCB, West Street, Horsham RH13 1PE for the account of the European Movement of the
UK Limited
(Account No. 61824848) (Sort code 40-24-33):
I hereby confirm that I am over 18 years of age:
Signature(s):
________________________________________________________________________
Signed: __________________________________________Date: __________________
[ ] This Standing Order replaces an existing one. [ ] This standing order is in addition to an
existing
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