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

 

 

 

 

 

Standing order form

Date: …………..

To the Manager ..………………………………….….… Bank 

 

Bank’s 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

 

Name of Account to be debited: …………………………………………

 

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