IHAI Standing Order Form

Standing Order Form (Republic of Ireland only)

To be sent to your bank manager

Manager:
		Bank name
Branch:
		Branch name
Address:
		Full branch address

		You are authorised to set up a Standing Order on my/our account as specified below. My/Our account will at all times contain sufficient funds to enable each payment to be effected on the annual date.

Signed:

Date:
		DD/MM/YYYY

Address:



		Please charge to my account:
Account Number:
Sort Code:

S/O Category:
(Bank use only)
Name of account:
Payment account ref. no:
Amount in Euro ( € ):
Frequency of S/O:
Date for payment:
		DD/MM/YYYY

Beneficiary Name:		Industrial Heritage Association of Ireland.
Beneficiary A/C Designation:		Current Account
Beneficiary's Bank Sorting Code No:		90-10-95
Beneficiary A/C No::		72915218