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To the bank manager at (name of your bank)     Bank
Please set up the following Standing Order and debit my/our account accordingly
 
Account Details
 
Account Name :   Account Number :  
Please write your name as it appears on your statement or bank card
Account Holding Branch :   Sort Code :  
 
Payee Details
 
Payee Name :   Sort Code :  
Sort code - the bank code of the person or organisation you are paying
Account Number :   Payment reference :  
Account Number - The account number of the person you wish to pay 01097701
Payment Reference : (official use please leave blank)
 
About the payment
 
For a one off contribution select :      Pay a single payment of £       on   

And/Or

A masjid page Sponsorship package :       Basic £5/Monthly       Comprehensive £15/Monthly
[There is a one off £25.00 set up fee. Thereafter, the amount you choose will be debited from your account monthly.]
 
Amount Details
 
Date of first payment :   Amount of first
payment :  
Please allow 3 working days for receipt
Date of ongoing
Amount of ongoing payments :  
if different from the first payment
Continue Payments Until further notice (Payments will be made monthly until you cancel this instruction)
Phone # :   Email Address :  
 
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