Midlands Sporting Association Ltd, Molineux Stadium, Waterloo Road, Wolverhampton, WV1 4QR
Telephone:
01902 658 666
Email:
[email protected]
You must accept these terms and conditions before signing up, so please read them carefully -
Terms and conditions
Customer Ref:
Schedule
Service/Schedule:
Wolves - Membership Lines - 1
Wolves - Membership Lines - 2
Termination:
Until further notice
Payment Information
Payment Day:
1
15
January
February
March
April
May
June
July
August
September
October
November
December
2025
First Payment Date:
01 May 2025
I wish to pay a regular Direct Debit of:
£4.34
Personal Details
Title
---Select---
Mrs
Mr
Miss
Ms
Dr
Sir
Lord
Lady
Prof.
Rev.
Master
Mx
---Other---
First name
Surname
Date of birth
Line1
Line2
Line3
Line4
Post code
Home phone number
Mobile phone number
Work phone number
Email
Additional Information
Can we contact you by Email?:
---Select---
Yes
No
Can we contact you by Mail?:
---Select---
Yes
No
Can we contact you by Phone?:
---Select---
Yes
No
Can we contact you by Text?:
---Select---
Yes
No
Do you agree to the terms and conditions? (You can review them at the top of the page):
---Select---
Yes
Instruction to your Bank or Building Society to pay by Direct Debit
APS Re Wolves Lottery, Wolverhampton Wanderers Football Club, Molineux Stadium, Waterloo Road, Wolverhampton, WV1 4QR
Service User Number:
Account holder name
Account number
Bank sort code
Please tick to confirm you are the only person required to sign for this account
Checking the box indicates that I am the Bank/Building Society holder and no authority other than my own is required. If more than one person is required to authorise debits from the account, you are unable to setup a direct debit online.
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