BANKER'S ORDER

(To protect details of our bank account, we will add them to the form when we  receive it)

To  ..................................................................................................   Bank PLC   (Your bank)

Address  ...................................................................................................................        BLOCK LETTERS PLEASE

To The PIPE ROLL SOCIETY

Please pay to the ...............................................................................................................................

................................................................................................................................ (our Bank)

on 1 June 2010 the sum of TEN POUNDS (£10.00) and make a similar payment on the same date each year until you receive further notice in writing from me.
This cancels any previous Banker's Order in favour of the PIPE ROLL SOCIETY.

Full Name ............................................................................................

Address ....................................................................................................   BLOCK LETTERS PLEASE

Signature   .....................................................    Date ................................

The Pipe Roll Society is a registered charity (no. 264199).