Name of Bank:

Sort Code:

Bank address:

Account name:

Account number:

Reference to be quoted (please write your first name and surname):

Please pay

Bedford Town Independent Supporters Society. Trading as “ The B.E.S.T

Lloyds TSB Bank

37 High Street Bedford
Sort Code:30-90-66
Account number: 3256521

Amount to be paid : £

Amount in words:

Date of first payment (e.g. May 1st 2008):

Signed:

Date: