I WOULD LIKE TO MAKE A STANDING ORDER

Name of your Bank:

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Address of your Bank:

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Bank Instructions:     Please pay the following amount --

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On the same day every month, starting on the                                     until further notice

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Sort Code:                                                                Account No.:

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Account Holder's Name:

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Email Address:____________________________________       Tel No.:______________________________

Signature:                                                                        Date:

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            CREDIT :    LSPCA                                    BANK:     ULSTER BANK, O'Connell St. Limerick

            SORT CODE:  98-60-20                             ACCOUNT NO.:    30709139

Please return to:

LSPCA, 289 Fr. Russell Square, Hyde Rd. Limerick

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I WOULD LIKE TO MAKE A ONCE OFF DONATION

Signature: _____________________________                        Date: ____________________________

Address: _____________________________________________________________________________

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E-Mail address_____________________________________      Tel No: __________________________