SEPA Direct Debit Mandate

	SEPA Direct Debit Mandate
	KILRONAN COMMUNICATIONS Ltd
	Keadue, Boyle, Co Roscommon

Unique Mandate Reference:

Creditor Identifier

IE59ZZZ307333

By signing this mandate form, you authorise (A) Kilronan Communications Ltd to send instructions to your bank to debit your account and (B) your bank to debit your account in accordance with the instructions from the Kilronan Communications Ltd.
As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited. Your rights are explained in a statement that you can obtain from your bank.

Please fill in your details here.
Post back to: Kilronan Communications Ltd, Keadue, Boyle, Co.Roscommon.

Name:
Address 1:
Address 2:
Town:
County:
(when available)Postal Code:
Country:
Account Number (IBAN)
Bank Code (Swift BIC)

Creditors Name:	Kilronan Communications Ltd
Creditors Address 1:	Keadue, Boyle, Co Roscommon
Creditors Country:	Ireland

Type of Payment::

Recurrent:

or One-Off Payment :

Date of signing:

Signature(s):