To the Manager, | |
Name of your bank:_______________________________________________________________ Address of your bank:______________________________________________________________ | |
Please pay: | The Ireland-Palestine Solidarity Campaign |
Account No: 23591022 Sort Code: 93-21-08 IBAN: IE63 AIBK93 2108 2359 1022 BIC No: AIBKIE2D | |
AIB, 140 Lower Drumcondra Road, Dublin 9 | |
Amount (in figures):__________ (in words):______________________________________________ | |
On the _______________ day of every month, starting on ____/____/____ (date of first payment) | |
From my/our account: | |
Your account name(s): | __________________________________ __________________________________ |
Your IBAN No: | _____________________________________ |
Your signature(s): | __________________________________ __________________________________ |
Date: | ________________________ |