Application Form
Name: ________________________________________________________________
Address: ______________________________________________________________
_______________________________________________ Post Code: _____________
I enclose a cheque/PO for £250 made payable to Peter Aziz. Or alternatively, if paying by
standing order, please insert your bank details below:
To (your bank) _________________________ Bank plc. Sort Code: _______________
Full Branch Address: _____________________________________________________
_____________________________________________________________________
Account Number: ____________ Name of Account (e.g. A. Smith): _________________
Signature: ________________________
Please pay the order of Peter Aziz, Acc No 31205331, at HSBC Bank, 57 High Street,
Totnes, Devon TQ9 5NS (Sort Code: 40-44-24) the sum of £25.00 (twenty five pounds only)
upon receipt of this mandate, and the same sum at intervals of one month thereafter, to a total
of ten payments.