SEP A Direct Debit Mandate I Unique Mandate Reference: Creditor Identifier :IE 50ZZZ302936 I
Hui:;h Jordan & Co
Unit 4 Airways Ind. Estate Sant[V2 Dublin 17
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By signing this mandate form, you authorise (A) Hugh Jordan & Co to send instructions to your bank to debit your account and (8) your bank to debit your account in accordance with the instruction from Hugh Jordan & Co.
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 complete all the fields below marked * Please return this form to Hugh Jordan & Co,Unit 4 Airways Ind. Estate, Santry, Dublin 17
* Your Name * Your Address * City/Eircode
* Account Number (IBAN) * Swift BIC
Creditors Name Creditors Address
Country * Type of Payment: * Date of Signing * Signature(s)
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I
* Country I I Hugh Jordan & Co
Unit 4 Airways Ind. Estate Santry, Dublin 17 Ireland