Labour Party Direct Debit
I would like to pay my annual membership to the Labour Party each year
by direct debit.
I understand that the membership fee can be increased by the National
Executive Committee.
Name ____________________________________
Address ___________________________________
___________________________________
DIRECT DEBIT FOR PARTY MEMBERSHIP
INSTRUCTION TO YOUR BANK TO PAY DIRECT DEBIT
Please charge to my/our Account Number _____________________
To: Labour Party, Galway.
Address: Constituency Office, Circular Road, Galway.
Bank : Bank of Ireland. Mainguard St., Galway.
Sort Code: A/C:
The sum of €15 €20 other (specify) ________
● Please write name and full postal address of your bank and branch
_____________________________________________________
● Name of Account Holder(s) ______________________________
● Sort Code ___________ Account number _________________
I instruct you pay direct debit from my account at the request of the Labour
Party. The amounts are variable and may be debited on various dates. I
understand that the Labour Party may change the amounts and dates only after
giving me prior notice. I will inform the Bank in writing if I wish to cancel this
instruction. I understand that if any direct debit is paid which breaks the terms of
this instruction, the Bank will make a refund.
Signed _____________________ Date / / 2011
Print and return completed form to:
The Treasurer, Labour Party, Bóthar na Long, Galway.
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