Standing Order Donation Form

Your Banking Details:

Bank:

Branch:

Branch Code:


Please Debit my account no:

               

Account Name:

 

Amount: Frequency (e.g. weekly, monthly etc.)

€  

Beginning (ddmmyy)

           


End Date or until further notice, please cross out one.

           


For Reference: (Your Full Name)

 


and pay to:

Bank of Ireland, Beaumont Hospital, Sort Code: 90-96-01
Account: Beaumont Hospital Foundation
A/C No: 58329781


Signed: _________________________________________________________

(authorised signature / account holder)

TAX FREE GIVING: To Reclaim Tax Download form from
www.bhf.ie/files/reclaimform.doc