Standing Order Mandate
To:........................................................................................Bank. Your Bank Postal Address: ............................................................................................ ............................................................................................ ............................................................................................ ............................................................................................ Please pay: Barclays, The Northampton Group, PO Box 23, Northampton NN1 4YD for the credit of: Neuroweb Ltd, PO Box 186, Northampton, NN1 3ZW. Account No: 909 465 83 SortCode: 20-61-51 the sum of: £11.75 (includes £1.75 VAT) Amount in words: eleven pounds and seventy five pence Commencing: Date of first payment .................................. and thereafter monthly until further notice. Please cancel all previous standing orders in favour of Neuroweb Ltd Your Account name to be debited: ........................................................ Your Account number: ........................................................ Your Sort code: ........................................................ Your Signature(s): ........................................................ Date: ........................................................ _____________________________________________________________________________ FOR OFFICE USE ONLY Standing Order reference ........................................................... MUST BE QUOTED!! _____________________________________________________________________________