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Home > Room Sponsor Direct Debit

Room Sponsor Direct Debit

Become a room sponsor today!

"*" indicates required fields

I would like to make a monthly gift to Cork Simon of:*

€10 per month

€15 per month

€21 per month

€50 per month

Other

If you are a taxpayer, a gift of €21 or more a month (totalling €250 or more in the calendar year) is worth at least an extra €112 to Cork Simon Community at no extra cost to you.

Your Details

Name*

First Last

Email*

Phone*

Postal Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Tell us what prompted you to become a Room Sponsor today:

Thanks for your support. We’d like to keep in touch with you about our work but your privacy is very important to us so please tell us how you would like to hear from us:*

Allow emails

Allow phone calls

Do not allow post

Your Bank Details

I would like my Direct Debit to be taken*

On the 1st of the month

On the 15th of the month

Name of account holder(s):*

Account Number (IBAN):*

Swift BIC:*

Can this account accept direct debits?*

Yes

No

Is more than one signatory required to sign on your account?*

Yes

No

This is a recurring monthly payment. Creditors Identifier No: IE085DD350058

Consent

By signing this mandate form, you authorise Cork Simon Community to send instructions to your bank to debit your account and your bank to debit your account in accordance with the instruction from Cork Simon Community.

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.

Make a Donation

Our vision is of a society without homelessness.

Company Information

Cork Simon Community is registered in Ireland as a company limited by guarantee, not having a share capital.

Company Registration Number: 42511 Registered Charity Number: 20022914
Revenue CHY Number: 9155
Registered office: 4 Lapp’s Quay, Cork, T12 KT61

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