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Standing Order Form. PLease print this form and take it to your Bank

06/03/2009 09:49

Standing Order Donation Form Your Banking Details: Bank:

Branch: Branch Code:

Please Debit my account no:

Account Name:

Amount: Frequency (e.g. weekly, monthly etc.)

Beginning (ddmmyy)

End Date or until further notice, please cross out one.

Quoting Reference No: (please give initials & house no e.g. NT31)

and pay to: Allied Irish Bank, A/C No: 32591180 Main St, Newbridge. Co. Kildare Sort Code: 93-32-44 Signed: _________________________________________________________ (authorised signature / account holder)


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Patsy Furlong Foundation Stabding order Form  

Please fill out your details and drop this form into your local branch. Your help is very much appreciated

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