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To:........................................................................................Bank.
Your Bank Postal Address:
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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: ........................................................
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FOR OFFICE USE ONLY
Standing Order reference ........................................................... MUST BE QUOTED!!
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