Application Form
Lottery Application Form.
Name ; Mr, Mrs, Miss.....................................
Address ; .....................................................
.....................................................
Postcode ;.................Tel ;............................
I would like.........numbers @£1 perweek.
I would like to pay by; (please select).
Standing Order.......Cheque.......Cash Collection.......
Bank Quoting Reference ;( for office use only.)
Ardgowan Hospice Standing Order Authority.
(Please complete only if paying by standing order.)
To, .........................................................Bank plc.
Address................................................................
.................................................Postcode.............
Please pay; Bank of Scotland
Sort Code ; 80-08-21
For the credit of ; Ardgowan Hospice Lottery
Account No ; 00171911
Account Name ; Ardgowan Hospice Lottery S/O Account
The sum of ;
£.......Every Week
£.......Every 4 Weeks
£.......Every 13 weeks ( Commence A.S.A.P. )
£.......Every 26 weeks
£.......Every 52 Weeks.
Account Name.......................................
Account No ;..........................................
Sort Code ;..........-........-..........
Signature ; ...........................................
Date ; ...........................................
Please print off, complete and return to Lottery Office.(Address below)