BANK STANDING ORDER MANDATE

To:                  ..............................................................................Bank

Branch Address:  ...............................................................................................

Please debit my/our account No.  .....................................................................

      with    £5.00 on the first day of each month

      or      £60.00 once each year

commencing on  ..................................................  date ...................

until you receive notice from me in writing,

and pay to:      LLOYDS BANKS P.L.C.

16 High Street, Burton-on-Trent. DE14 1JA.

 SORTING CODE No: 30-91-47

to credit of:       Burton Football Club 200 Club. Account No.1552147

Name:          ...............................................................................................

Address:         ...............................................................................................

Signature:         ................................................................................................

Dated:            ..................................................  date ...................





Send completed mandate to