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           Standing Order

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What to do with this form

This form needs your signature to be processed by the bank, please print it out, sign it, and then post it to us (address opposite).

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To The Manager, Name of Bank or Building Society

Address of branch

Account Number 

Sort Code          

Please Pay to One In Four Ireland Ltd, Bank of Ireland A/C no. 91501467, Sort code 901490,the sum of

Amount in words

Please make payments:

Monthly    

Quarterly  

A single payment  

 

Commence date  (DD/MM/YY)

Name

Phone

Address

Signature

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Contact Information

We would like to thank you personally if its ok with you and keep you informed of the work we are doing......                                  

                

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Email address

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Contact information

Support and resources for people who have experienced sexual abuse and/or sexual violence.