Standing Order form

WEST CORK ANIMAL WELFARE GROUP

STANDING ORDER MANDATE

To: The Manager of (Bank, Building Society):

Branch (Full Postal Address):

Name on your Bank/Building Soc. Account:

Branch Sort Code:

Your Bank Building Society Account Number:

Your address:

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

Date:

Signature: