| To: The Manager of (Bank, Building Society):
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| Branch (Full Postal Address):
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| Name on your Bank/Building Soc. Account:
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| Branch Sort Code: |
| Your Bank Building Society Account Number: |
| Your address:
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| Start Date: Ref: (Your name and initials)
|
|
I/We authorise you until further notice in writing to
debit my/our account with the sum of £………….on the ….. …. Day
of each month for the benefit of:
West Cork Animal Welfare Group
Trustee Savings Bank
Clonakilty Branch
Rossa Street
Clonakilty
Co. Cork
Account number: 71649440 Sort Code 99-07-12
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| Date: |
| Signature: |