Bank Standing Order Mandate


Bank Name:	________________________________________

Bank Address:	________________________________________

		________________________________________

		________________________________________

		________________________________________


Account No:		________________________

Sort Code:		___ - ___ - ____

Account Holder Name:	___________________________________


Please pay the sum of
£__________         (_______________________________ Pounds only)
(Amount in figures) (Amount in words)

on ____________ and weekly/monthly/quarterly/annually thereafter,
  (Date)            (Delete as appropriate)

until further notice, to:


Account Holder Name:	Sheffield Royal Society for the Blind
Sort Code:	20-76-89
Account No:	40192147
Reference to Quote:	Donations

This mandate replaces all previous instructions in favour of
Sheffield Royal Society for the Blind.



_________________________________       __________________
(Account Holder Signature)              (Date)


Please complete and return to:
The Sheffield Royal Society for the Blind,
5 Mappin Street, Sheffield S1 4DT