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Euro Standing order form
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* Indicates required question
First Name
*
Your answer
Surname
*
Your answer
Email
*
So we can send you a confirmation.
Your answer
To the Manager of
Name of your bank
*
Your answer
Address of your bank
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Your answer
Name on the account
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Your answer
Your address
*
Your answer
Your telephone no.
*
Your answer
IBAN
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Long number
Your answer
BIC
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Your answer
I/we hereby auhtorise and request you to debit my/our account with the sum of: (in numbers)
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Your answer
Amount in words
*
Your answer
Frequency
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Once per month
Required
To start on
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MM
/
DD
/
YYYY
and to Credit the account of the Irish Bible Institute
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Bank: AIB, 40/41 Westmorland Street, Dublin 2. BIC AIBKIE2D / IBAN IE47AIBK93338424208082
Yes
Required
Account holders signature
Please leave blank and we will send a copy of this form to you for signature. Thank you.
Your answer
Instructions to your bank. I instruct you to pay this standing order from my account and I will inform you in writing If I wish to cancel this instruction
*
MM
/
DD
/
YYYY
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