PLEDGE OF SUPPORT TO CLONGOWES WOOD COLLEGE FOUNDATION

MY/ OUR GIFT TO CLONGOWES FOUNDATION Family Name: First Name(s): Address: Phone (Mobile):

Phone (Home):

Email:

PAYMENT INFORMATION My/ Our total gift of € Single payment on

to Clongowes Foundation will be paid by: /

/ 20

(date)

Monthly payments over 12 / 24 / 36 / 48 / 60 months from start date Annual payments over 1 / 2 / 3 / 4 / 5 / 6 other (

/

) years from start date

/ 20 /

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(Please choose payment method) BY STANDING ORDER: This can be set up through your online banking or alternatively by completing the attached standing order form and returning to: Clongowes Foundation, FREEPOST, Clane, Co. Kildare. Please note this must be returned to Clongowes Foundation and NOT directly to your bank. BY BANK TRANSFER: AIB Private Banking, Ballsbridge, Dublin, 4. IBAN: IE96 AIBK 9303 9303 0650 45 | BIC: AIBKIE2D BY CHEQUE/ CASH: Cheques made payable to Clongowes Foundation and post to: Clongowes Foundation, FREEPOST, Clane, Co Kildare. Signature:



Date:

TAX INFORMATION Self-Assessed and PAYE Donors will be issued with a CHY3 Form, which allows Clongowes Foundation to claim 31% Tax Refund from Revenue on donations. Corporate Donors will be issued with a receipt for Tax purposes. Further information is available on www.clongowes.net

DEDICATION & RECOGNITION Your gift may be dedicated to a family member, friend or loved one. Dedications will be remembered annually at the Clongowes Mass of Thanksgiving for Benefactors and Donors. My/ Our preferred name or dedication for recognition purposes is Please note that donors are listed by donor name, the amount of individual gift is not published. I/ We would prefer not to be listed in Clongowes Wood College donor lists

STANDING ORDER SET UP FORM Please complete in BLOCK CAPITALS using black or blue pen.

To the Manager: Bank Name: Bank Address:

I/We hereby authorise and request you to DEBIT my/our account. Sender BIC: Sender IBAN: Amount: €

Amount in words:

And to CREDIT: Clongowes Wood College Foundation BIC: AIBKIE2D | IBAN: IE96 AIBK 9303 9303 0650 45 AIB Private Banking, Ballsbridge, Dublin, 4.

Receivers reference (NAME OF Donor): Please allow 5 working days prior to first payment Start date (DD/MM/YYYY):

/

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Frequency (Please X Box) Weekly Fortnightly Monthly Quarterly Annually End date (DD/MM/YYYY):

Signature:

/

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Date:

It shall be understood that the Bank shall not be under any liability for damage or loss caused by any omission to make these payments.