STANDING ORDER FORM

STANDING ORDER FORM

To the Manager...............................................................................Bank plc
(Subscriber's own bank)

Address......................................................................................................
.......................................................................................................
.....................................................Post Code.................................

Please pay to Lloyds TSB Bank plc, 1 High West Street, Dorchester DT1 1UG

Branch Sort Code 30 - 92 - 69

on (date)...................................................

and in each succeeding month / quarter / year until further notice, (delete as appropriate)

the sum of £..........................

for the credit of the Dorset Historic Churches Trust Account No: 0412179

Signed........................................................Date.......................................

Name (in BLOCK CAPITALS, with title)

...............................................................................................................

Address...................................................................................................
................................................................................................................
..................................................................Post Code..............................

GIFT AID DECLARATION

Name (in BLOCK CAPITALS, with title)

I am a UK taxpayer, and wish all my donations to the Dorset Historic Churches Trust to be treated as Gift Aid,
so that the Trust may claim refund of the tax I have paid on these sums.

Signed...................................................................Date............................

Please send this order and Gift Aid Declaration to:

The Hon. Treasurer
Dorset Historic Churches Trust
The Thatched House
1, Manor Farm Close
Pimperne
Blandford DT11 8XL