100 Club Standing Order Form

Please deliver this form to your bank

 Name of Bank: ____________________________________________________

 Branch Address: __________________________________________________

 _________________________________________________________________

 Post Code: _____________

 

 Name on Your Account: _________________________________________

 Your Account Number: __________________________________________

 Pay To: Clydesdale Bank, Glasgow Head Office, 30 St Vincent Place, Glasgow G1 2HL

 Credit: Account No: 10485818 (Chess Scotland)

 Amount per month: _______ pounds

 Please commence the above payment on the 25th of ________ (month), 20___

 and monthly thereafter until cancelled by me in writing

 

 Signed: ____________________________________

 Your Name: ________________________________

 Date: ______________________________________

 

 

Chess Scotland Treasurer, David Congalton, 12F Townhead, Irvine, Ayrshire, KA12 0BE (Tel:01294 273114).