Ruislip Cricket Club
Adults Membership Form
This payment form is in respect of the annual membership for Ruislip Cricket Club. Membership must be paid in full before 1st April in each respective season or a payment plan set up. Please complete below as appropriate and return form to the club or email to bhupinderphull@sky.com. Please complete personal & payment details below.
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Full Name of Member:
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Full Address with Post Code:
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Contact Number(s):
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Email:
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Emergency Contact Name & Contact Number:
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1. I am a full playing member and understand the annual subscription is
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£120
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[ ]
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2. I am a social member and understand the annual subscription is
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£20
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[ ]
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Our account details for payment are:
[REDACTED ONLINE]
When making payment please reference your full name and email bhupinderphull@sky.com.
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- [ ] I Have paid the full amount of £_____ for the annual subscription by cheque/online/cash.
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Payment Date:
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Payment Reference:
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- Card Payment
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Name on Card:
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Card Type:
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Visa/Visa Debit/MasterCard/Other?
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Card Number:
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Start Date:
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End Date:
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3 Digit Security Code:
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Issue Number:
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Please debit my card for: [ ] £20.[] £40. [ ] £60. [ ] £120.[ ] other amount of £
[ ] As a single payment after 1st April
[ ] Two/Three/Four monthly payments after 1st April . Each payment to be £
Last payment taken will be for balance to ensure full amount is paid.
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Card payments carry a small surcharge of £1.50 per transaction to cover our costs. No Amex or Diners Club.
- New Standing Order Payment Instruction
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To:
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Bank/Building Society
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Name on Account:
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Account Holding Branch:
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Account Details:
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Sort Code:
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Account No:
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Payment reference (Name):
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Payee Details:
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Recipient:
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Ruislip Cricket Club
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Payment Reference (Your name):
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Sort Code:
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20-73-53
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Account Number:
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70781509
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Payment Details (choose one below)
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[ ] Yearly
Date of first payment: 1st April and annually on the 1st April thereafter until further notice. Payments will be made until you cancel this instruction.
Amount of payment:[ ] £20pa.[ ] £40pa. [ ] £60pa. [ ] £120pa. [ ] Other amount £____
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Instalment options for full playing members only;
[ ] Monthly.
Date of first payment: 1st April.Amount of first payment: £_____
Subsequent payments to be taken in the 1st of each month thereafter. Amount of ongoing payments: £10pm until further notice (£120 per season). Payments will be made until you cancel this instruction.
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Signed:
Full Name: Date: