Patron Scheme Application Form - Sean McCaffrey Foundation

Please complete the following application form to become a member of the Sean McCaffrey Foundation Patron Scheme.

Your standing order start date will be on the 25th of the current or next month from sign up.

If you wish to pay monthly (€8.50 per month) please notify us in the additional information box provided.

Use your full name for Beneficiary Reference.

*You can choose to stop your standing order to the Sean McCaffrey Foundation Patron Scheme at any time by contacting your bank.

Full Name (required)

Address

Street Address

Address Line 2

City

County

Your Eircode

Phone Number (required)

Your Email (required)

Date:

Payment Method:
CashStanding Order

STANDING ORDER SET-UP FORM

SEAN MCCAFFREY FOUNDATION PATRON SCHEME

To the Manager

Branch Address

I/We hereby authorise and request you to debit my/our account
(details of the account from which payments will be made)

Account Name

BIC (optional)

IBAN

And to credit the Beneficiary/Receiver Account
(details of the account from which payments will be made)

Account Name: SEAN MCCAFFREY FOUNDATION CLG
BIC (Optional): AIBKIE2D
IBAN: IE84AIBK93247732638015

Beneficiary/Receiver Reference

Start Date:

Frequency:
AnnuallyMonthly

Amount: One off Annual Payment €100.00 or 12 Monthly Payments of €8.50 per month

Additional Information

Signature

Date: