200 CLUB BANKER'S STANDING ORDER

To: The Manager,

.................................................................Bank/Building Society

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Please pay the sum of:-

a) £12 on the 1st September until cancelled by me in writing

b) £6 on the 1st September and £6 on the 1st March until cancelled
by me in writing.

(Please delete as appropriate)

To: The Dover Grammar School for Boys,
Parents & Friends Association - 200 Club,

Lloyds Bank plc,
Market Square,
Dover, Kent.
Account Number: 1797588
Sort Code Number: 30-93-34

Name...................................... Account Number...........................

Address..........................................................................

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Signature.......................................... Date..................