BANKER'S ORDER

Please print and complete this form and sent with your membership application

To the Manager.........................................................................Bank

Your branch address.........................................................................

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Your account number.........................................................................

Please pay the sum of £......................now and annually hereafter on 6th April to Lloyds Bank plc, Farnham, Surrey, for the Farnham Society A/c 0119575

Your signature.................................................................

Your name......................................................................

Address..........................................................................

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Date................................................................................