ASH Animal Rescue Cornan, Kiltegan, Co. Wicklow, Ireland. Phone: 00353 (0)508 73396 Email: ashlm@eircom.net Website: www.ashanimalrescue.com

Friends of ASH

I would like to become a Friend of ASH to help support the good work carried out by the sanctuary in rescuing and offering refuge to animals in need.

My details:

Name: ___________________________________

Address: ___________________________________

              ___________________________________

              ___________________________________

Phone: ____________________

Email: ___________________________________

Date: ____________________

Signed: ___________________________________

Donation details:

I would like to donate by:

_ Cheque (enclosed)
_ Standing order / bank transfer

Amount of donation: ______

This donation is:

_ A single donation
_ A monthly donation
_ A quarterly donation (every three months)

(Please check which box applies)

Please print and send this page only to the secretary of ASH at the following address for our records:

ASH Animal Rescue Cornan, Kiltegan, Co. Wicklow, Ireland. Phone: 00353 (0)508 73396 Email: ashlm@eircom.net Website: www.ashanimalrescue.com

Standing Order Form

If you are setting up a standing order, please fill in this section and give to your bank

Standing order details:

To the bank manager

Bank name : _________________________

Bank sorting code : _________________________

Bank address : _________________________

_________________________

_________________________

Account name : _________________________

Account number : _________________________

Please transfer the sum of ________ from the above account to:

Bank: Allied Irish Bank, Main street, Baltinglass, Co. Wicklow, Ireland.
Sorting code: 93-31-04
Account name: Animal Sanctuary Hubasha
Account number: 40053008

Please transfer this sum:

_ Once only
_ Once per month effective from the date of this order until further notice
_ Once every three months effective from the date of this order until further notice

(Please check the box above that applies)

Date: ______________

Signed: ____________________________________