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YOUWIN CLUB APPLICATION FORM

Cirencester Town ‘YouWin’ Club Application Form

Print this form, complete and return to:

‘YouWin’ Club, CTFC, The Corinium Stadium, Kingshill Lane, Cirencester, Glos, GL7 1HS

Name:

Address:

Postcode:

Telephone:

Mobile:

Commencing date for your ‘YouWin’ subscription:

NB 1st of the month

Payment Options Tick
One years subscription (£120) by Cheque Enclose cheque payable to CTFC

OR I would like to pay by standing order

Please complete the Mandate below, deleting the payment option that does not apply

BANK STANDING ORDER MANDATE

To : The Manager, Bank/Building Society:

Your Bank Name:
Branch Name:

Bank Address:

Bank Postcode:

Please debit my/our account and transfer the payment indicated below to the account of:

Cirencester Town Football Club, Kingshill Lane, Cirencester, Glos, GL7 1HS

Please pay to:
LloydsTSB plc, Castle Street, Cirencester, Glos

Sort Code 32-92-06 Account Number 0066905

(Delete the sum that does NOT apply)

EITHER

The sum of £120 (one hundred and twenty pounds sterling) on 1st day of 2008 and annually thereafter.
OR

The sum of £10 (ten pounds sterling) on 1st day of January 2008 and on the 1st day of each month thereafter.

Debit my account

Number:
Sort Code:

Signed	Date

Print Name

Signed	Date

Print Name