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Instruction to your Bank or Building Society to pay by Direct Debit.

Please complete and return with the completed membership form to Usdaw.
Just write FREEPOST USDAW on the envelope and put it in the post.

Service User Number

Name and full postal address of your Bank or Building Society
To: The Manager
9 7 4 0 4 0
Bank/Building Society
Reference Number
Address

For U S D A W Official Use Only (This is not part of the instruction to your bank or building society)
Postcode
Full name
Name(s) of account holder(s)
Branch No.

Home Address
Bank/Building Society account number
Postcode

Instruction to your Bank or Building Society. Please pay the U S D A W Direct Debits from
the account detailed in this instruction subject to the safeguards assured by The Direct Debit
Branch sort code Guarantee. I understand that this instruction may remain with U S D A W and if so, details will
be passed electronically to my Bank/Building Society.

Signature(s) Date
Banks and Building Societies may not accept Direct Debit instructions for some types of account.