To the Manager (name and address of your bank)

Name:_______________________________________________

Address:_________________________________________________________

_______________________________________________ Post code ________

Please pay Plant a Tree in Africa
[Co-operative Bank Sort Code 08 92 99, Account No. 65075850] direct debits from
the account detailed on this instruction, in the sum of:

£___________ each month commencing on ______________ (date) until otherwise

instructed by me in writing.

Name(s) of account holder(s):_________________________________________

Branch sort code _________________ Account No. _______________________

Name(s): _____________________________________________

Address: ___________________________________________________________

__________________________________________________ Post code ________


Signature:___________________________ Date _____________


Please return this form to Plant a Tree in Africa,
48 Churchward Ave, Swindon, Wilts SN2 1NH (not to your bank)