Bank Standing Order
To: The Manager,
Name of Bank/Building Society
Your bank or building society details
Address
Post code
Please pay to:
Your instructions		 Prostate UK
Allied Irish Bank (GB)
Sort code 23-84-82   Account No. 41087068
The sum of:
Amount in words:
Every:
(Tick appropriate box)		 Month     Quarter     Year
Starting on:  
(Please choose a start date at least one month from now)		   /     /      (dd/mm/yy)
From my Account: Name
Account number
Your account details
My address:
(for cross referencing your donations)
Signed  
Date  

Please print this form, complete it and send it to us at Prostate UK,
6 Crescent Stables, 139 Upper Richmond Road, London, SW15 2TN.   Back from this page.