ESVD Payment Form 2011 Bank Transfer - final

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ESVD Payment Form 2011 Bank Transfer - final Powered By Docstoc
					                 BANK TRANSFER FORM
                         2011
        ANNUAL MEMBERSHIP FEE FOR ESVD MEMBERS

                    PAYMENT FORM (send to your Bank)

Name

Address




                                                      Zip Code/
Country
                                                      Post Code

                   Payment by International Bank Transfer in Euro €
                    (WITHOUT ANY CHARGE FOR THE RECEIVER)

                   ANNUAL FEE:..................................... 100€/60€
   (Discounted rate applies if on-line subscription to Veterinary Dermatology only is
                   required or for qualifying ‘young’ dermatologists)

 I authorise the transfer of my fee from my Bank account to ESVD Bank account:

    Name of
   your Bank


Note to Bank   Please include FULL NAME of the customer requesting this Bank Transfer when
IMPORTANT      notifying ESVD of AVIS DE CREDIT




  Address of
  your Bank




ESVD ACCOUNT NAME:           European Soc Vtrnry Drmtlgy Ltd
BIC:                         MIDLGB22
IBAN:                        GB10 MIDL 4005 1569 7570 61
BANK ADDRESS:                HSBC, Fore St, St. Marychurch, Torquay, UK TQ1 4ND

NB:    Please complete this Form in FULL and send it to your bank, then send a
       completed Annual Membership Payment Form to the Treasurer of ESVD.
       ..Thank you..

				
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posted:1/28/2011
language:English
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