Manorhamilton Rangers AFC

 


Print copy and complete details and send to address below.

 

      Manorhamilton Rangers Football Club AFC Ltd,

      C/o Joe Cleary, Treasurer,

      Lisnabrack, Manorhamilton,

      Co. Leitrim.

 Manorhamilton Rangers Development Club Member Details

Manorhamilton Rangers Club Member Number:

Name:

Contact Address:

 

 

Home Phone Number:                                  Mobile Number:

 

Email Address:

 

 

Please detach above for club records

*

To: The Manager,                                                        (Name of Your Bank)

 

You are authorized to set up a standing order on my/our account as specified below. My/our account will at all times contain sufficient funds to enable each payment to be effected on the due date.

Signed: _____________________________

Address:_____________________________

            ______________________________

            ______________________________

 

Account Number:

Name on Account:

Account Holders Name (if different from above)

 

Start date:

Frequency:     Monthly

Amount: €20.00 (Twenty Euro)

 Beneficiary Details:

Name: Manorhamilton Rangers Football Club Limited

Bank: AIB, Manorhamilton.

Account Number: 01815077

Sorting Code: 937134 (Manorhamilton)

Please return this form to Joe Cleary, Manorhamilton Rangers Treasurer, Lisnabrack, Manorhamilton, Co Leitrim. Please do not send this form direct to your bank as the club requires a copy of the form for correspondence.