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) LIMITED
Bank: Tide Bank
Sort Code: 04-06-05
Account Number: 21915954
Reference: [ENTER YOUR FLAT NUMBER]