To the Manager, _________________________________________________
_________________________________________________________________
(Your Bank's full postal address)
Please pay to CAF Bank Limited, 25 Kings Hill Avenue, Kings Hill, West Malling, Kent ME19 4JQ (sort code 40-52-40) to the credit of FRANCE MISSION No 1 ACCOUNT (account number 00016479) the sum of
£ _________________________
(the amount you wish to give each month)
on the first day of _________________
(the date you wish payments to start)
and monthly on the same day thereafter until further notice, quoting the following reference with each payment: ____________________.
(please leave blank)
Signed: ______________________________
(Sign here)
Date: ___________________
(Today's date)
Your account number: ___________________________________
Your Bank's sort code: ______ : ______ : ______
(Please copy these figures from your cheque book)