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STANDING ORDER MANDATE

Name:

 

Address:

  

 

Bank Name:

 

Bank address:

  

Bank Sort Code:

 

Account Number:

 

Account Name:

 

Please pay to: "Friends of Animals", Account No. 07221099, Allied Irish Bank, 11 Oliver Plunket St., Mullingar, Co. Westmeath, Eire.

Monthly amount

Amount in words:

 

 

 

First payment due:

 

And thereafter on

 

day of each month, until further notice

 I / we authorise you to debit my / our account in accordance with instructions given above:

 Signature:

 

Date:

 

 If the account that is the source of the funds has both parties to sign, other party must also sign below:

 Signature:

 

Date:

 

 Thank you for your support and generosity - Please return completed Form to your Bank :