Your Name: _______________________________________________________________
(BLOCK CAPTIALS PLEASE)
Address: _________________________________________________________________

_________________________________________________________________________

______________________________________Post Code __________________________


Sort Code: ______ - ______ - ________ Account Number: ___________________

Your Bank Name: _________________________________________________________

Bank Address: ____________________________________________________________

_________________________________________________________________________

______________________________________Post Code __________________________

Please Pay for the credit of: (tick appropriate box)

[   ] Patagonia Steppe Wilderness Appeal
[   ] Fundaçion Jocotoco (Ecuador)
[   ] Amazon Basin Rainforest Fund
[   ] World Land Trust Central Funds
[   ] Friends of Belize
[   ] Danjugan Island Support Fund
      (formerly the Philippine Reef and Rainforest Project)

Sort Code: 20-92-08             Account Number: 70985848

Barclays Bank, Halesworth Branch, Waveney Valley Group, 12 Broad Street Bungay, Suffolk NR35 1EW, £___________ to be paid on ____________________ and the same amount on the same day of each month/year (please delete) until further notice.


Signed:_________________________________________________ Date:______________

If you would like to support more than one project by Direct Credit, please use another form and complete separately.