Standing Order

Account Holder's Name

First

Last

Bank or Financial Institution Name

Bank Branch Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Contact Email

Contact Start Bank

Contact Phone Number

Standing Order Start Date

Frequency

Amount to be Paid or Transferred

Beneficiary Name: Loughgilly Parish Trust

Beneficiary Account Ulster Bank Newry

Sort Code 98-11-40

Account Number 14410270

Parish Envelope Number

Authorization

I hereby declare that the above information is correct and that I authorize this order.

Signature

Clear Signature

Parish of Loughgilly