Standing Order Mandate Form

Standing Order Mandate Form
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityCounty

Eircode
Phone Number*

Area CodePhone Number
Your Bank Details
To the Manager*
Name of Bank/Building Society
Branch Address *

Street Address

Street Address Line 2

CityCounty

Eircode
Your Account Details
I authorized you/the bank to debit my account using the details below:
Bank Name*
Branch Name & Location*
Account Number*
Account Name*
Sort Code Number*
IBAN number*
BIC *
Payment Details
I request that you pay to the Bank of Ireland, Main St, Dundrum, Dublin 14 (90-10-95) for credit to account Agapé Ministries Ireland, IBAN IE09BOFI90109582 813960, BIC: BOFIIE2D
Amount
Amount*

€21*€30€50Other
*Tax Reclaim: any donation of €250 (€21 monthly) from a PAYE or self-assessed tax payer, Agapé can reclaim the tax on your donation at the flat rate of 31%. This means your donation can be worth an additional €112.32, at no additional cost to you. The reclaim will be credited to your designation.
Amount in words*
Frequency*
Start Date*

MonthDayYear
Date
Staff member or Project Designation*
Date Signed

MonthDayYear
Date
Signature

Clear
Please keep me updated about Agapé via:

EmailPost
Should be Empty:

Your Bank Details