Please debit my account the total detailed below each month until further notice to:

Account/recipient name: St. Joseph the Worker Catholic Church, Hutton

Sort code: 40 13 22
Account number: 61018884

HSBC
91 High Street
Brentwood
Essex
CM14 4RU

Standing order request

Please debit my account the total detailed below each month:

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Contact details

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Home Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Post code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please sign through your browser or leave empty and submit the form. Then print the PDF and sign before returning to a member of the team at the Church.

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Notes

This instruction cancels any previous payments to St. Joseph the Worker Catholic Church

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Data processing and storage

In order to comply with UK legislation on data protection, by submitting your information you confirm that you are happy for St. Joseph the Worker Catholic Church, Hutton to process and store your data for the purposes outlined above. 

Read our full Privacy Policy here.

YesNo NoYes
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If you do not wish for your information to be stored in line with our privacy policy, please contact us to discuss the options available to you.

Please debit my account the total detailed below each month until further notice to:

Account/recipient name: St. Joseph the Worker Catholic Church, Hutton

Sort code: 40 13 22
Account number: 61018884

HSBC
91 High Street
Brentwood
Essex
CM14 4RU

Standing order request

Please debit my account the total detailed below each month:

Monthly amount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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First payment on: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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{ binding firstError.message }

Contact details

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Home Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Home Telephone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Mobile Telephone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Name of your bank {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Your sort code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Your account number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Your bank's address: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Post code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Notes

This instruction cancels any previous payments to St. Joseph the Worker Catholic Church

{ binding firstError.message }

Data processing and storage

In order to comply with UK legislation on data protection, by submitting your information you confirm that you are happy for St. Joseph the Worker Catholic Church, Hutton to process and store your data for the purposes outlined above. 

Read our full Privacy Policy here.

Data processing confirmation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Please debit my account the total detailed below each month until further notice to:

Account/recipient name: St. Joseph the Worker Catholic Church, Hutton

Sort code: 40 13 22
Account number: 61018884

HSBC
91 High Street
Brentwood
Essex
CM14 4RU

Standing order request

Please debit my account the total detailed below each month:

Monthly amount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
First payment on: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Contact details

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Home Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Home Telephone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Mobile Telephone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Name of your bank {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Your sort code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Your account number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Your bank's address: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Post code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Notes

This instruction cancels any previous payments to St. Joseph the Worker Catholic Church

{ binding firstError.message }

Data processing and storage

In order to comply with UK legislation on data protection, by submitting your information you confirm that you are happy for St. Joseph the Worker Catholic Church, Hutton to process and store your data for the purposes outlined above. 

Read our full Privacy Policy here.

Data processing confirmation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Cognito Forms{{ Cognito.resources["powered-by-cognito"] }}