Please initiate a Standing Order payment for your entr(y/ies) to:

St Mary's '200' Club at the Bank of Scotland, Broadford, Isle of Skye

St Mary's Sort Code and Account Number:

Name of Purchaser:                                                  

Address of Purchaser:                                                     

Purchaser's Sort Code/Account Number:                   

Address of Purchaser’s Bank:

Amount in words:                               

Amount in figures:                                   Frequency (monthly/yearly):

Purchaser's Signature:                                                                 Date: 

(There is no limit to the number of £2.50 monthly or £30.00 yearly entries you can have)