To set up a Standing Order please complete and print the form below and hand it to your bank. To print this page click file and print.
Alternatively call your bank to make these arrangements.


Your name : ______________________________________________________________

Address:   ________________________________________________________________ 

___________________________________________        Postcode   _________________ 

To: The Manager ( bank's name & address)    


Please pay the Dog Rescue Appeal Fund the sum of: EUR10.00 EUR20.00 EUR30.00  

Other EUR ________________     EUR (amount in words)   __________________________

Each month until further notice and debit my account

Account Number     __ __ __ __ __ __ __ __

Sort Code            __ - __ - __

Starting on (date) _______________________________ and each month  thereafter.

Signature   __________________________   Date   ______________

For bank use only
Please pay to:
Account Name: Dog Rescue Appeal Fund
A/C No.  21039588
Bank of Ireland, Blackrock
Bank Sort Code 90-10-28

Dog Rescue is a registered charity reference number CHY13313