Text Box:     Bankers Order Form for Cottage Rescue.

          I wish to make a regular donation of   €  _____: _____

   Each Month:                       Until further notice:                      

    Starting on
                                             
       Please pay to:
                            Hannah Fitzgerald, Cottage Rescue Personal Account,
                              A.I.B. Bank, Main Street, Cashel, Co Tipperary.

    Sort Code:  93-50-69     Account Number:   02653074

   Name:   _______________________________________________

    Telephone No: _________________________________________

    Address: ______________________________________________            
                  __________________________________________ 
                  __________________________________________

  Account Number:  _____________________________________
    
   Sort Code: 

    Your bank details:  (name and address of bank)  
    ___________________________________________________

    ___________________________________________________

    ___________________________________________________
                         
   Signature: __________________________  Date: ________________ 

     Please return this completed form to:  
     Cottage Rescue, Longfield,  Cashel,  Co Tipperary.   
     (Not to your bank.)  Thank you for your kindness.

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