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The Irish-Chinese Cultural Society

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					STANDING ORDER MANDATE                          PLEASE COMPLETE IN BLOCK CAPITALS

To:…………………………………………………………………………………………… (your bank’s name)


Branch Address      …………………………………………………………………………….………………………


          …………………………………………………………………………………………………………………….

Please set up a standing order as follows:

€30.00 (Thirty Euro), once a year,

to start from    _ _/_ _/2 0 _ _    , until such time as I give notice otherwise,
from

Account Holder Name:       …………………………………………………………………………..

     Account Number: ………………………………. Sort Code: …………………………………..

to

Bank of Ireland, Bray Branch, 45 Main St, Bray, Co Wicklow
Account No: 80198925 Sort Code: 90-10-36
Account Name: The Irish-Chinese Cultural Society.


Signature:………………………………………………………………………Date:…………………………………

==================================================

Please return the completed form to the Hon. Treasurer :
Jenny Slevin-Williams, Hon. Treasurer,
10 Kilbegnet Close, Dalkey, Co.Dublin

who will forward the above portion to your bank.

For our records:
Your Name:…………………………………………………………………………………………………………………..


Address: ……………………..……………………………………………………………………………………………


…………………………………………………………………………………………………………………………………….


…………………………………………………………………………………………………………………………………….

Telephone Number: …………………………………..................

Email Address: ……………………………………...........................................................

				
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