Thank you for becoming a Radiothon Friend for Life!
To sign up for a monthly direct debit, please fill in the information on this form.
You will be asked to fill in banking details on the next page.
SEPA Direct Debit
You are currently being signed up to a SEPA direct debit. This means that no signed paper Direct Debit instruction is required. When you complete your donation we will send you a letter indicating the details of your direct debit donation with Cork’s 96FM Giving for Living Radiothon.
Creditor Identifer: IE54SDD360676
Mercy University Hospital Foundation,
26 Henry St., Cork.
Tel. 021 4274076
By completing this mandate form, you authorise (A) Mercy University Hospital Foundation to send instructions to your bank to debit your account and (B) your bank to debit your account in accordance with the instructions from Mercy University Hospital Foundation. 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.
You can cancel your Direct Debit at any time by contacting the Mercy Hospital Foundation or by informing your bank.