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Bronwydd Cricket Club

 

100 Club Membership Application Form

 

 

Payments can be organised on a standing order / direct debit or by a single yearly payment.


 

Name:           ……………………….…………………………………….…………………

Address:       ………………………………….……………………….……………………

                                    ……………………………….……………………….………………………

……………………………….…………………….…………………………

……………………………..…….………  Postcode: ……………..………

Tel / Mob:    ……………………….…………………………………….…………………

E-mail:          ……………………….………………………………….……………………

 


Account to be debited

 

Bank:   …………………………………………………………..  

 

Account Number:  ……………………………………    Sort Code:  …………….………..

 

Amount of 1st payment:  ……………………………………….  (Amount of usual payment  -  £5)

 

Date of first payment:    …………………………………

 

Amount of usual payment in words:  ……………………………………………………….

 



 

   When paid:     Monthly               (Date of payment will be the 1st day of each month.)                  



 

   Please continue until further notice:              YES         

 

 

Customer signature:  …………………………………………………..      Date:  ……………………

 

Beneficiary Details

  Your much needed support helps

Bronwydd Cricket Club 100                                  Bronwydd Cricket Club to provide the

Bank: NatWest                                                     best facilities it can for all our players

Account Number:                                                  and supporters.    

Sort Code:                                                                                                  

Join now and help Bronwydd Cricket Club!!

Quote Reference:                                                 

 

www.bronwydd.play-cricket.com




Please complete the form (leave the 'beneficiary details' blank) and return to Steven Phillips