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Renewing your membership

Individual monthly

Membership Fee

Amount: £ 3.00 Date: 30 Oct 2018, 20 : 43

Membership form

Declaration [x]I/we accept the party’s aims and do not belong to any other political party.

First Name Eoin

Middle Name

Last name Teather

Address line 1 23

Address line 2 Steade Road

Address line 3

City Sheffield

Postal Code S7 1DS

Country United Kingdom

UK landline

UK Mobile 07595974759

Are you a Student? ( )Yes (x)No

Date of birth 11 Dec 1966

Billing Name and Address

Eoin Teather

23
Sheffield
S7 1DS
GB

Your Email

snowcrane@btinternet.com

Direct Debit Information

Thank You For Setting Up a Direct Debit Payment.

The first payment will be collected on or around 01 Dec 2018.

Below is the Direct Debit Guarantee for your information.

Instruction to your Bank or Building

The Green Party Society to pay by Direct Debit
The Biscuit Factory
Unit 201 A Block Service User Number
100 Clements Road 9 7 3 6 6 9
London
SE16 4DG Reference:

Name(s) of Account Holder(s) TGP00429922

Iain Teather Instruction to your Bank or Building

Society
Bank/Building Society Account Number Please pay The Green Party Direct
00012181 Debits from the account detailed in
this Instruction subject to the
Branch Sort Code safeguards assured by the Direct
Debit Guarantee. I understand that
404760
this Instruction may remain with The
Green Party and, if so, details will be
To the passed electronically to my Bank /
Manager Bank/Building Building Society.
Society
Date 30 Oct 2018
HSBC UK BANK PLC

Branch FIRSTDIRECT 4760

Address

40 Wakefield Road

Leeds

LS98 1FD
Banks and Building Societies may not accept Direct Debit Instructions for some types of
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The Direct Debit Guarantee

This Guarantee is offered by all banks and building societies that accept instructions to
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If there are any changes to the amount, date or frequency of your Direct Debit The
Green Party will notify you 10 working days in advance of your account being debited or
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If an error is made in the payment of your Direct Debit, by The Green Party or your bank
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