Lime Tree House – Standing Order Mandate Form

To (Bank / Building Society)

Address

Account Name to be Debited

Account Number

Sort Code No.

Please pay:
Bank: The Royal Bank of Scotland plc, Altrincham Branch. Sort Code No: 16-12-11
Beneficiary's Name: Mountlands Trust Limited (T/A Lime Tree House)
Account No: 12503627

The sum of £ ................ (Amount in words)

Commencing (date of first payment)

And thereafter every (due date and frequency)

Until (date of last payment) and debit my/our account accordingly

Signature(s)

Date

Please return this form to: 'The Administrator', Lime Tree House, 264 Washway Road, Sale, M33 4RZ.

Lime Tree House: Standing Order Mandate Form