Eccleshall Branch Postal Donation

Last updated Monday August 25, 2008

Eccleshall Conservative Branch

Mr/Mrs/Miss/Ms/ Other __________________

Mr and Mrs____________

Other: ________________

Address:______________________________________________________________

________________________________________________ Postcode ____________

I/We wish to contribute the following amount: £15 £20 £25 £30 £35 £40 £45 £50 Other Amount (Please Specify) £

Method of payment

Enclosed is a subscription of £___________ (Cheques payable to Eccleshall Branch Conservative Association)
Bankers Order Conservative Branch Donation

To………………………………… Bank

Branch…………………………………

Address………………………………..

…………………………………………

Account Number………………………..

Members Name…………………………

Address…………………………………

………………………………………….

Please pay to the Eccleshall Branch Conservative Association A/C Number 03511200 Natwest Bank, 13 High Street, Eccleshall.

Sort Code 52-41-10

The sum of £

On…………………………… (date)

And also a like amount on day of each year succeeding until this order is cancelled

Signed ………………………………

Date ……………………………….

Please print off and send this form to:

Mathew Richardson c/o

Ivan Jennings 18 Chapel Terrace, Stafford, ST163AH