WIMBORNE RUGBY CLUB
Season 2007 / 2008

WIMBORNE RFC 200 CLUB

Please return form to:
Mike Wickenden, 13 Portchester Rise, Allbrook, Eastleigh, Hants. SO50 4QS.
Tel 02380-641892 Mob 07710 257723
or email wikz@btopenworld.com


To___________________________ Bank (your bank details)

__________________________________________ Branch
Sort Code _________________

Account name (block caps)

_______________________________________
Account no.

__________________________
   

Please pay to WRFC 200 Club:-

the sum of £ ____ ( __________________________ )
amount in words

  
on 5th of each month, commencing ( ________________ ) until further notice
                   insert month
  
under ref _________ (leave blank)  

crediting the account held at Barclays Portsmouth
Sort Code 20-69-34 A/c No. 70382019

Signature________________________________

Date ___________