Lincoln City Football Club - "Imps Birthday Lotto" Application Please use BLOCK CAPITALS Name: _______________________________________ Address: ________________________________________________________________ _______________________________________________________________________ Telephone Number: ____________________ Choice of Birthdate: ______ / _______ / _______ Signature: ______________________________________ Amount I wish to pay: £52 annually £26 half yearly £13 quarterly £4.33 monthly I enclose a cheque / postal order for the above stated sum Please charge my debit / credit card for the above stated sum Visa Mastercard American Express Switch (issue no. ________ ) Card Number: ___________________________ Expiry Date: _______ / _______   I wish to pay by Standing Order To (your bank): ___________________________ (address): ____________________________________________________________ Commencing: _____ / _____ / _____ Account Name: _________________________ Sort Code: ____________________ Account Number: _________________________ Signature: ______________________   Please pay:- Account Name: 'Imps Birthday Lotto' Lincoln City Football Club Co Ltd Account Number: 70231100 Sort Code: 08-90-32 Address: The Co-operative Bank, 16 Saltergate, Lincoln, LN2 1DG. Please complete and return this form to: to 'Imps Birthday Lotto', Lincoln City F.C., Sincil Bank, Lincoln, LN5 8LD For further enquiries please telephone 01522 563785 Cheques/Postal Orders made payable to Lincoln City Football Club