To: ..............................................................................................................................................................
( Name & Address of Member’s own bank )
Account number: ................................................ Sort code:........................................
Please pay to Barclays Bank plc, Surbiton Branch, Kingston-upon-Thames Business Centre, 6 Clarence Street, Kingston-upon-Thames, Surrey. KT1 1NY ( 20 - 46 - 73 ) for the account of The Association of Government Veterinarians ( Account No. 20122572 ) the sum of £25 (Twenty five pounds) on the first day of May each year unless otherwise notified.
Please cancel any previous standing orders payable to account 20122572.
NAME: .............................................................. Signature:............................................
( BLOCK CAPITALS PLEASE )
Date: ...................................................
ADDRESS:
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