Payment Request Form

(PLEASE USE CAPITAL LETTERS)

FLAT NUMBER

FULL NAME

MOBILE PHONE NUMBER

EMAIL ADDRESS

[  ]  FOB KEY - £20
[  ]  BICYCLE STORAGE - £20 a year per bicycle
[  ]  GENERAL STORAGE - £12 a year per item (suitcase or box)

Comments:

Name (Resident):________________________ Signature:______________ Date:___ /___ /______

Please make a bank transfer into the following account. Please enter your flat number in the reference.

Recipient: SUSSEX HEIGHTS (BRIGHTON) LTD
Bank: Barclays Bank
Sort Code: 20-12-80
Account Number: 03567125
Reference: [ENTER YOUR FLAT NUMBER]