Download GONDAR (ETHIOPIA) EYE SURGERY

GONDAR (ETHIOPIA) EYE SURGERY
BANK STANDING ORDER MANDATE
To: Bank ……………………………………… Sort Code .............................................
Branch ................................................................................................................................
Address ..............................................................................................................................
.............................................................................................................................................
Please make the payments detailed below debiting my/our*
Account number ……………………………….
Please pay to:
HSBC, Abergavenny, sort code 40-08-04, Gondar (Ethiopia) Eye
Surgery, Account no 71423800.
starting on the …….……….… day of …….………………….……………. 200………
the sum of ...........................................................................................................................
and the same sum on the same day Monthly* Quarterly* Annually* until further notice
Donor’s name and initials in capitals:
(Mr/Mrs/Miss/Ms/Title) .....................................................................................................
Address ..............................................................................................................................
.............................................................................................................................................
Signature ............................................................................................................................
* delete as appropriate
Please do not send this form directly to your bank,
Send it to:
Gondar (Ethiopia) Eye Surgery
Cefn Maen, Usk Road, Raglan, Mon NP15 2HR
Charity Number 1101246