SHANNON RFC DEVELOPMENT LOTTO
DIRECT DEBIT INSTRUCTION
Please Debit my account in the amount of €25 Euro on …………………. and quarterly thereafter.
Name & Address of Account							Account Holders Signature
							Date
							I	I	I
To the Bank Manager:
				Bank Sort Code
		Bank Account Number
SHANNON RFC				National Irish Bank
				19 Patrick Street, Limerick
Bank Account Number:
	6	1	0	4	8	0	5	8
Sort Code:
	9	5	1	6	8	7
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	Name & Address
					Lotto Numbers 1-30