Standing Order Form

Registered with Broadland District Council No. BDC/247 – Gambling Act 2005

Maureen Smith – Promoter
tel: 01603 869482  || email: maudie@trevorsmith.org
8A Station Road, Attlebridge, Norwich, NR9 5AA

Please complete and print before signing both parts then send to the promoter at the address above.

After processing your completed form, we will forward your standing order instruction to your bank or building society and will confirm to you in writing the date when your monthly contributions are due to start.  Each stake, in each monthly draw costs £5.00 and you may buy as many stakes as you wish.  We pay out half the value of the monthly stakes as prizes, while the other half contributes to the  ‘Hall for All’  operating costs.  Thank you very much for your support.

Part A - Your details







Part B - Standing Order instructions







INSTRUCTION: Please pay to Lloyds TSB Ltd the monthly amount stated above on the 10th day of next month and again on the 10th day of each subsequent month, quoting the following details with each payment.

Sort code: 30-92-88
Account Number: 23479668
Name of account: Hall for All 100 Club


(Click/Touch the Print Icon to print the Standing Order Form)