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           Standing Order


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).


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:



A single payment  


Commence date  (DD/MM/YY)






Contact Information

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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.