Bank ....._________________________ (name of your bank)

Branch.. ________________________ (name of your branch)

Branch Address ___________________________________________________________________________

................... _________________________________________________________________________
 

Sort Code _____________________

Amount £_________ and in words _____________________

Commencing _____________ (date) or immediately if blank

And every month / year thereafter until canceled (delete as appropriate)

Quoting reference: ______________________ (name or membership number)

Barclays Bank, Diss Branch, Norfolk
Account Name : Safe Speed
By BACS
to Barclays Bank
Due to Fraudulant activities please note the numbers have now been written out IN REVERSE - this will help us stop the 'website troughing of details' issues.

Sort Code four three, six two, zero two
Account five one seven zero one zero zero five.
Then your reference : Username & name

If using BACS payments reference with your name and Username (as it appears on the Safe Speed Forum)

From Account Number ______________ ........................ From Account Name _______________________________

My Full Name ..__________________________ My Username ______________________________

My Full Adress _____________________________________________________________________

....................._____________________________________________________________________

Signed __________________________  Date _________________