Standing Order

1. Complete the form below, either on the computer or by hand.

2. Print it off

3. Fax it to 020 7820 0057 or post it to: Landmine Action, 89 Albert Embankment, London SE1 7TP

Name:
Address:
Postcode:
Telephone:
I would like to make a regular donation by bankers order.
Name of Bank/Building Society:
Address of Bank/Building Society:
Bank Postcode:
Account Number:
Sort Code:
Please pay Landmine Action:
Every:	Month Quarter Year
Begining date:
Your Signature:
Click here to print this form