STANDING ORDER INFORMATION

Yes - I want to help TIC by standing order.

As an ADDITION to the main response form, please print and fill in this second sheet if you would like to donate money to us on a regular basis through a standing order.  Please fax or send BOTH pages to us at the following address:

Teens in Crisis, Unit 6/13, The Mews, Mitcheldean, Glos, UK, GL17 0SL

FAX:  +044  (01594) 544281

To The Manager of

Bank PLC

Address

Postcode

Please pay to:

Teens In Crisis, Account No 2285763, of Lloyds Bank PLC,
50 High Street, Ross-On-Wye, Herefordshire, HR9 5HJ.
Sort Code: 30-94-14

*

Please delete as appropriate

The sum of £.................................. (in words)
Every  *Week / Month / Quarter / Year

Commencing on the 10th day of .....................  199.....

Please pay this from:

Title

Full Name

Address

Postcode

Account No.

Sort code

Signature

Date