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Standing Order Confirmation Form
The bank details are:
Bank: Bank of Scotland, 172 High Street, Musselburgh, EH21 7EA
Account Name: MASC
Account Number: 00221095
Sort Code: 80 – 17 – 68
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Email
*
Your email
I can confirm I have set up my standing order for Musselburgh ASC and it will leave my account on the 7th of the each month
*
Yes
No
Name of Swimmer 1
*
Your answer
I have setup the following amount for Swimmer 1
*
Your answer
Name of Swimmer 2
Your answer
I have setup the following amount for Swimmer 2
Your answer
Name of Swimmer 3
Your answer
I have setup the following amount for Swimmer 3
Your answer
Parent/Guardian name who filled out the form
*
Your answer
Date the form was filled out
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MM
/
DD
/
YYYY
Any issues or questions, please contact the COVID Lead Team on
masccovidteam@gmail.com
A copy of your responses will be emailed to the address you provided.
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