To the Manager (insert name of  bank)   _____________________________________

Insert address of bank_________________________________________________

PLEASE DEBIT my Account No.___________________ Sort Code:____________and PAY to WOMENAID (Registered Charity No. 299224) Lloyds Bank plc., 14 Berkeley Square, London W1X 6BJ   (Account No. 0132024, bank sort code 30-96-48)

the sum of ___________ on the__________________ day of__________________200__ and annually/monthly/quarterly thereafter on the same date until a total of _________annual/monthly/quarterly payments have been made or until further notice..

Signed___________________________________________ Date:_____________

Name (block letters)___________________________________________________________

Address____________________________________________________________

Postcode___________________________________________________________

Thank you for committing to give regularly.  Please indicate if you are giving monthly, quarterly or annually.   Please print the bankers order form, complete and send it to:

WOMENAID INTERNATIONAL  
womenaid@womenaid.org 

E-mail: support@womenaid.org

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