100 Club Monthly DD Form

Please complete the form below and your 100 club monthly payment will be deducted from your bar card account on or around 20th day of each month.

Enter not this field:

Members Details

100 Club Rules:*
	I have read the Rules governing the 100 Club and understand that £5 will be deducted from my bar card monthly until cancelled by me in writing.

Comments:

Electronic Signature (Please tick the box below)

Signed:*

*Indicates a field you must enter.

When you have completed the form, please click the Send Details button ONCE to send