Butterfly Conservation Direct Debit Form

Butterfly Conservation

Direct Debit Form

Instruction to your Bank/Building Society to pay by Direct Debit

I WISH TO PAY
	Annually		Quarterly	( please tick one )

TO THE MANAGER
	( name of Bank/Building Society )

BANK/BUILDING SOCIETY DETAILS
Address:
Branch Sort Code:

Please pay Butterfly Conservation Ltd Direct Debits from the account detailed on this Instruction subject to the safeguards assured by the Direct Debit Guarantee.

ACCOUNT DETAILS
Name of account holder(s)
Bank/Building Society account number:

PLEASE SIGN AND DATE
Signature(s)	Date

Banks and Building Societies may not accept Direct Debit instructions for some types of accounts.

Butterfly Conservation

Direct Debit Form

The Direct Debit Guarantee

This guarantee is offered by all Banks and Building Societies that take part in the Direct Debit Scheme. The efficiency and security of the scheme is monitored and protected by your own Bank or Building Society. If the amounts to be paid or the payment dates change, you will be told of this in advance by at least 14 days. If an error is made by us or your Bank/Building Society, you are guaranteed a full and immediate refund from your branch of the amount paid. You can cancel a Direct Debit at any time by writing to your Bank or Building Society. Please also send a copy of your letter to us.

Originator No 941164

From time to time we would like the opportunity to contact you with relevant information about our work. However, if you would prefer not to receive this information, please tick the box below.
	I do not wish to receive information about the work of Butterfly Conservation.

When complete please return the form to:
Butterfly Conservation
Manor Yard, East Lulworth
Wareham, Dorset BH20 5QP

For Office Use Only