Regular Gift & STO

If you would like to make a regular gift to Brent Bereavement Services, complete the form below, print and send the form to the following address.

We can then set up a banker's order for you.

Brent Bereavement Services
Willesden Community Hospital
Harlesden Road
Willesden
London
NW10 3RY

Please complete your details below

Title

First Name

Last Name

Address

Postcode

Year of birth

Telephone number

Mobile number:

E-mail

Banker's Order - instruction to your bank/building society to pay by banker's order.

Name and full postal address of your Bank or Building Society

To the Manager
(bank name):

Bank address:

Postcode:

Exact name(s) of account holder(s):

Branch Sort Code:

/ /

Bank/Building Society account number:

Please complete your details below

Instruction to your Bank or Building Society (please allow 1 month before first payment)

Please pay on the:

(day) of (month) (year) and on the same day of each succeeding until further notice to:

Natwest Bank PLC., 12 Station Road, Willesden Green, London, NW2 4NN.

Sort code 60-24-04. Account No. 64133338.

The sum of £

Standing Order Form
Title:
First Name:
Last Name:
Address:


Postcode:

Year of birth:
Telephone number:
Mobile number:
E-mail

Banker's Order - instruction to your bank/building society to pay by banker's order.
Name and full postal address of your Bank or Building Society:
To the Manager (bank name):
Bank address:


Postcode:
Exact name(s) of account holder(s):
Branch Sort Code:	- -
Bank/Building Society account number:
Please complete your details below: Instruction to your Bank or Building Society (please allow 1 month before first payment) Please pay on the (day) of (month) (year) and on the same day of each succeeding month/quarter/year (please delete as appropriate) until further notice to: Natwest Bank PLC., 12 Station Road, Willesden Green, London, NW2 4NN. Sort code 60-24-04. Account No. 64133338. The sum of £ I hereby confirm that I am over 18 years of age Signature(s)___________________________ Date _______ /_______ /_______ Bank Reference:

Thank you!