Appeals
MINIBUS APPEAL
| STANDING ORDER FORM |
|---|
| Bank/Building Society Account Number :☐☐☐☐☐☐☐☐☐☐ |
| Sort Code:☐☐-☐☐-☐☐ Start date of payment:☐☐ /☐☐ /☐☐☐☐ |
| Date of final payment ☐☐ /☐☐ /☐☐☐☐ OR until further notice YES☐tick box |
|
I instruct my Bank/Building Society to pay a monthly payment of £________________ (enter amount in words: ___________________________) from the account detailed above to: The Asian Health Agency HSBC Bank Account Number: 41617710 Sort Code: 40-42–13 Please return Standing Order form to your bank or to: TAHA, Shanti Centre, 89 Askew Road, London.W12 9AS |
| Signed:_____________________________Date: ☐☐ /☐☐ /☐☐☐☐ |