Name
and Address:
..
..
..
Please
indicate clearly who you want to sponsor.
I want to sponsor PENSIONER FAMILY
CHILD
AT KINDERGARTEN
CHILD AT HOMEWORK CLUB
VOCATIONAL SCHOOL STUDENT
PLEASE INDICATE WHAT APPLIES
I enclose a Lump sum
donation of £
.
(£16 X 12 months = £192; £25 x 12 months = £300)
I wish to pay by standing order and have filled in the
attached standing order form.
I have set up a standing order direct with my bank and
enclose details
Date: ..
Banks address
..
Please pay the sum of
..
in
words & figures starting on
.
.
and thereafter every month* / quarter* on the
day until I/we cancel these instructions.
* Delete as appropriate
Account number:
Bank Sort Code:
Account to be
credited: Mustard Seed [Jersey] Sponsorship Account, HSBC, St. Brelade, Jersey.
Account number: 51143638 Bank Sort Code: 40-25-41
Signature/s:
.
Please return this to: Mustard Seed [Jersey], Cardiff House, Coin
Varin, St. Peter, Jersey JE3 7EJ