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STRATFORD TOWN INDEPENDENT SUPPORTERS ASSOCIATIONLOTTERY APPLICATION FORM

NAME: ……………………………………………………………………………………………………………………………………

ADDRESS: ………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………………….

…………………………………………………….POSTCODE: ……………………………………………………………………..

EMAIL: …………………………………………………………………..TEL: ……………………………………………………….

I WISH TO JOIN THE STISA LOTTERY, THE MONEY RAISED IS TO ENABLE US TO CONSIDER PURCHASING OR REPLACING EQUIPMENT WHICH OTHERWISE STFC MAY NOT BE ABLE TO FINANCE.

THE COST FOR JOINING THE STISA LOTTERY IS £5.00 PER MONTH AND WILL BE COLLECTED BY STANDING ORDER ONCE A MONTH. PLEASE FILL IN FOLLOWING BANK DETAILS:

YOUR ACCOUNT NO: BANK SORT CODE:

PLEASE PAY TO LTSB, 22 BRIDGE STREET, STRATFORD UPON AVON, CV37 6AG, SORT CODE 30-98-26 ACCOUNT NUMBER 66794668

THE SUM OF ON THE DAY OF EACH MONTH, UNTIL FURTHER

NOTICE COMMENCING

YOUR LOTTERY NUMBER IS

SIGNATURE …………………………………………………………………….. Date ……………………………………

YOUR BANK:

BRANCH ADDRESS:

ACCOUNT HOLDERS NAME:

£

/ /

STRATFORD TOWN INDEPENDENT SUPPORTERS ASSOCIATIONLOTTERY APPLICATION FORM

SIGNED BY STISA …………………………………………………………….