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: