| STANDING ORDER MANDATE
- Cancel all previous mandates under this reference
To: ............................................... Sort Code..................... ..................................................... .....................................................(Insert your Bank address) Please pay the undernoted standing order with effect from ...../....../..... Signature................................................ Date ..........................................
Pay to Bank Of Scotland, Mitchelston, Kirkcaldy Sort Code 80 - 16 - 84 Account Name : Raith Rovers Independent Supporters' Society Account Number : 00368691 Reference number :
Delete one option as applicable - Pay the sum of ..............(figures)......................................................(words) every month commencing...../......./........ until further notice OR Pay the sum of ..............(figures)......................................................(words) annually commencing...../......./........ until further notice
From my account Account Number.............................................................. Account Name ................................................................ |