IRISH MATHEMATICAL SOCIETY - Request for Standing Order
Please present the completed form at your bank
To the Manager
Name of Bank : ..............................................................................
Branch
: ..............................................................................
Address
: ..............................................................................
: ..............................................................................
Please charge to my/our account
Name of Account : ..............................................................................
Account Number : ..............................................................................
And pay to
The Irish Mathematical Society
Bank of Ireland
Maynooth
Co. Kildare
Code No. 90-15-03 Account No. 57781485
The amount stated below commencing with the first payment on
............................................................................................................
and continuing with a payment on 31 January of each following year.
Amount: 25 euro.
Please quote Payment Reference Number: ..........................[your name]
Any existing order in favour of the Irish Mathematical Society is hereby
cancelled and replaced by this order. My/our account will at all times contain
sufficient funds to enable each payment to be effected on the due date.
Signed : ..............................................................................
Address : ..............................................................................
: ..............................................................................
Date
: ..............................................................................