SECTION A - PERSONAL DETAILS
Title
Forename(s)
Address (including Postcode)
Contact Telephone No
Surname
D.O.B
Mobile Telephone No
E-Mail Address
SECTION B
–
SEASON TICKET REQUIREMENT (HIGHLIGHT SELECTED TICKET)
Category Adult Concession 16-17 / Student Under 16
Price
Early Bird**
£
300
£
280
£
£
185
165
£
£
150
135
£
£
40
35
Flex 15
£
195
£
120
£
100
£
30
* ID will be required when purchasing a Concession Season Ticket. Please read attached Terms and Conditions carefully where details of required ID are provided
**To qualify for Early Bird Price payment must be made in full by midnight Tuesday 30 th June 2015
SECTION C – PAYMENT TERMS (PLEASE TICK ONE BOX)
Single Payment Easy Payment
(Please select)
3 6
SECTION D – PAYMENT
Cost of Required
Ticket (Enter cost of ticket)
Method of
Payment (Please tick one option)
Cash
Cheque

Debit / Credit Card
Standing Order Form Attached***
*** If selecting this option, please complete and return a copy of the attached Standing Order
Form
Please return your completed application to one of the following:
• Postal Application - Gateshead FC Season Ticket Applications, Gateshead Football Club, The
International Stadium, Neilson Road, Gateshead, Tyne and Wear, NE10 0EF
• e-Mail completed application to info@gateshead-fc.com
Name of Bank / Building Society: ___________________________________________
Branch Address:
Name of Account to be debited monthly:
Sort Code:
Name of Payee :
Account No:
Gateshead Football Club
Bank Details: Lloyds TSB Bank PLC, 102 Grey Street, Newcastle, NE1 6AG
Sort Code: 30-93-71 Account No : 00848145
Payment Details
First Payment: (enter date of first payment)
Amount in Figures:
Amount in Words:
Followed by further payments (enter either 2 or 5 )
Frequency: MONTHLY
Amount in Figures:

Amount in Words:
Signature: Date
• Please send this completed form to your Bank / Building Society or set up the standing order via your online banking facility