CASH DONATION FORM


Bankers Order

To the Manager

                                                                                                                                                  Building Society/Bank

Branch Address                                                                                                                                                             

                                                                                                                                                                                        

                                                                                                                                                                                        

                                                                                                                     Post Code                                                

Please pay HSBC Bank, 65 High Street, Ruislip HA4 8JE for the credit of The Myosotis Trust
(Sort Code: 40-39-13, Account No: 11177419)

every month/year the sum of: £                in words                                                                                                      

starting on (dd/mm/yyyy)           /           /                   

Name                                                                                                                                                                             

Address                                                                                                                                                                         

                                                                                                                                                                                        

                                                                                                                                                                                        

                                                                                                                   Post Code                                                   

Sort Code                                           Account Number                                                                                               


Signed                                                                       


Date                                                                           
the
myosotis
									trust

Please, print this form and post it to:

Mrs. Carol Daniel

“Glas Y Gors”

1 Fronhenlog, Cemmaes

Machynlleth, Powys

SY20 9PY