This form instructs you bank or building society to make payments direct from your account.
Please tell us the name and postal address of your bank:
Branch sort code:
Name of account holder:
Please pay Cairde Screen:
Account number: 45066601
Sort code: 90-49-82
Bank details: Bank of Ireland, 11 Market Street, Magherafelt BT45 6EE
The sum of:
House No and Street
By submitting this form I consent that my details will be used by Cairde Screen.