Vita Standing Order Donation Form

I would like to become a friend of Vita and give a regular monthly gift by Standing Order

There is no minimum amount – every Euro makes a real difference to a person’s future. By donating €21 or more a month Vita will benefit from tax relief from the Irish Government. This makes the value of your donation to Vita considerably greater than your original contribution.

Please complete the form instructing your bank/building society to make payments directly from your account

To The Manager Bank Name: Bank Address:                   Please charge to my account the sum of          €21* €50 €100 €150 other amount €        *There is no minimum amount – every Euro makes a real difference to a person’s future. By donating €21 or more a month Vita will benefit from tax relief from the Irish Government. This makes the value of your donation to Vita considerably greater than your original contribution.          Commencing on // Monthly / Quarterly / Yearly                   Name: Address:          Account Number: Sort Code:                   Beneficiary Name: Vita Beneficiary’s Bank: Bank of Ireland, Kill O’The Grange, Co Dublin Account Number: 12 98 67 35 Sorting Code: 90 11 83                   Signature: Date: //

Please note standing orders can only be set up with a current account. Please print and send the signed and completed form to Vita Equity House 16-17 Upper Ormond Quay, Dublin 7 Vita will process your information and forward the form to your bank. The first donation will come out of your account on the date you specify.