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Card number: Valid from:Expiry date:/5x10Signature: After we have processed your card payment we will separate your card details from the rest of this form and securely destroy them, and not store these anywhere on our system, in line with PCI regulations.Bank/building societySignature(s)1 8 1 7 4 0 Instruction to your Bank or Building Society Please pay Bluebell Wood Childrens Hospice Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct...
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