I would like to support White Eagle’s work and become a member of The White Eagle Lodge.
Name (In capitals)………………………………………………………………………………………
Address ………………………………………………………………………………………………………………………………………
………………………………………………… Post Code …………………… Signature ………………………………………………
Address ………………………………………………………………………………………………………………………………………
………………………………………………… Post Code …………………… Signature ………………………………………………
We are warmly grateful for your support and will write shortly to welcome you! If you would like to add a brief personal letter with your application, we are always pleased to have this more personal contact. The form below can be used to become a Member at the subscription rate appropriate for you. We do hope you will help us by using the Direct
Debit and Gift Aid Declaration forms for your subscription.
For Gift Aid Declaration form and alternative methods of payment, please click
here
I wish to pay as follows:-
(please make instruction monthly if possible)
(please make instruction monthly if possible)
By
Direct Debit: Instructions to your Bank or Building
Society to pay by Direct DebitOriginators identification number
Name and full postal address of your Bank or Building
Society
Please pay The White Eagle Lodge Direct
Debits from the account detailed on this instruction subject to the safeguards
assured by the Direct Debit Guarantee. I understand that this instruction
may remain with The White Eagle Lodge and, if so, details will be passed
electronically to my Bank or Building Society. Banks or Building Societies
may not accept Direct Debit instructions for some types of account. Note
to subscriber: debits are normally effected on the 6th of the month.
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The Direct Debit Guarantee |
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•This Guarantee is offered by all Banks and Building Societies that accept instructions to pay Direct Debits •If there are any changes to the amount, date or frequency of your Direct Debit The White Eagle Lodge will notify you 28 working days in advance of your account being debited or as otherwise agreed. If you request The White Eagle Lodge to collect a payment, confirmation of the amount and date will be given to you at the time of the request. |
•If an error is made in the payment of your Direct Debit by The White Eagle Lodge or your Bank or Building Society you are entitled to a full and immediate refund of the amount paid from your Bank or Building Society. If you receive a refund you are not entitled to, you must pay it back when The White Eagle Lodge asks you to.
•You can cancel a Direct Debit at any time by simply contacting your Bank or Building Society. Written confirmation may be required. Please also kindly notify us. |
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Please return to:
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The White Eagle Lodge,
Brewells Lane, Rake, Liss, Hampshire, GU33 7HY © 2010The White Eagle Lodge
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Form F12/2010/Issue 5 |