Standing Order Mandate

To the Manager
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Address Line 2
Address Line 3
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Postcode

Please pay the sum of £5.00 (FIVE Pounds) on the ___ ___ ___ ___ and thereafter on the 1st April anually until further notice to the credit of The Exmouth Grammar School Reunion, ACCOUNT NUMBER 87050242 at The National Westminister Bank, Oxford North Branch, SORT CODE 60:16:07 249 Banbury Road, Summertown, OXFORD, OX2 7HR

Signed
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Quote ref: ___ ___ ___ ___ ___
(Please leave the above blank for our completion)