Instruction to your Bank or Building Society:

Name of bank/building society: ..................................................................................
Bank/building society address: ...................................................................................
                                                  ....................................................................................
                                                 Postcode: ....................................................................

Name(s) of account holder(s): ....................................................................................
Account Number: ........................................................................................................
Branch Sort Code: .......................................................................................................

Please pay The Friends of the Old Church, Walesby, the sum of £...........  monthly/quarterly/annually, 
starting on:  
                       ............................................... (insert date)

Sort Code: 53-81-47       Account Number: 04628586

Signature(s):  ...............................................................................................................
                      ...............................................................................................................
Date:            .........../............../.................

Please return this form to The Friends of the Old Church, Walesby  -  NOT your bank.

Address:  Friends of the Old Church, The Treasurer, Blaven, Walesby Hill, Walesby, 
Market Rasen, Lincolnshire LN8 3GW. 
Friends Website: www.walesbyvillage.uk / Friends of the Old Church

Thank you for your donation and we look forward to welcoming you as a Friend of this historic church.

Registered Charity no. 512140