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HARLOWSAVE CREDIT UNION

a savings & loans co-operative

STANDING ORDER FORM

Name and address of your BANK

(Adult Member)

Harlowsave Credit Union Ltd 2 Wych Elm Harlow, Essex CM20 1QP

Your Name.................................................. Your Member Number _________ (if known)

Please pay: Unity Trust Bank Plc , Sort code: 08-60-01 Account number: 53100339 Account name: Harlowsave Credit Union Ltd The sum of £_____________ ______________________ pounds and _______________ pence

on 5th/18th/28th of ___________________________________ 200___ and then £ ___________ at *weekly / fortnightly / monthly intervals until cancelled by me/us in writing. (Note: some banks do not allow fortnightly.) * DELETE THOSE THAT DON'T APPLY. * This replaces a previous standing order for the transfer of £ _________ to the same account. *DELETE IF NONE EXISTING The name(s) on your account (print): ________________________________________________________

Account number __________________________________________Sort Code ______________________

Signature ____________________________________________________Date: _____________________

Please return this form to the office, not direct to the bank.

Harlowsave Credit Union Ltd is authorised and regulated by Financial Services Authority. Firm ref. no. 213273

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