Patron Renewal Form

Patron Renewal Form I would like to join as a Sadler’s Wells Patron: Opening night Patron

£600 (£567.00 DD)

Commissioning Patron

£1000 (£945.00 DD)

New Production Patron

£2500 (£2362.50 DD)

Season Patron

£5000 (£4752.00 DD)

Name.…………………………………………………………………………………..

Address.………………………………………………………………………………. ………………………………………………………………………………………….. …………………………………………………… Postcode…………………………

Telephone……………………… Email………………………………………………

Joining as a Patron entitles you to be acknowledged in Sadler’s Wells programmes. Please enter below how you wish to be acknowledged or whether you would prefer to remain anonymous …………………………………………………………………………………………

I would also like to give a donation of £……………………………………………

Payment Details I would like to renew by credit card Visa

MasterCard

Switch

American Express

Card number: Expiry Date

Security Code

Issue No. (Switch Only)

Name of card holder as it appears on the card: …………………………………………………………………………………

Card Holder’s Signature………………………………………………………………………

I would like to renew by cheque

(Cheques to be made payable to Sadler’s Wells Trust Ltd)

I would like to renew by direct debit

Direct Debit is a simple form of automatic annual renewal and helps us to reduce administration, receive a 5.5% discount on the price of your membership when you pay by Direct Debit.

I would like to pay (tick as appropriate): Monthly Quarterly Annually Instruction to your Bank or Building Society to pay Direct Debit (please complete in full) To the manager of__________________________________Bank/Building Society Address ___________________________________________________________ __________________________________________________________________ Postcode___________________________

Originators Identification No 6 5 2 7 9 8 Reference No. (Office use only) Instruction to your Bank or Building Society to pay by Direct Debit – Please pay Sadler’s Wells Trust Ltd. Direct Debits from the account detailed in the instruction subject to safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with Sadler’s Wells Trust Ltd and, if so, details will be passed electronically to my Bank/Building Society

Name(s) of Account Holder(s)_______________________________________________ Sort Code_______________Bank/Building Society/Account No_____________________ Signature_______________________________________________________________ Date _____________________________

Banks and Building Societies may not accept Direct Debit instructions for some types of account