STANDING ORDER MANDATE |
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Name: |
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Address: |
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Bank Name: |
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Bank address: |
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Bank Sort Code: |
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Account Number: |
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Account Name: |
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Please pay to: "Friends of Animals", Account No. 07221099, Allied Irish Bank, 11 Oliver Plunket St., Mullingar, Co. Westmeath, Eire. |
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Monthly amount |
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Amount in words: |
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First payment due: |
And thereafter on |
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day of each month, until further notice |
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I / we authorise you to debit my / our account in accordance with instructions given above: |
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Signature: |
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Date: |
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If the account that is the source of the funds has both parties to sign, other party must also sign below: |
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Signature: |
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Date: |
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Thank you for your support and generosity - Please return completed Form to your Bank :