Club Internacional  D’Andorra

 

                                            DIRECT DEBIT AUTHORIZATION

 

I hereby give permission for my annual subscription to the Club Internacional d’Andorra to be directly debited to the following account:-

 

 

Name:.................................................................................................................................

 

 

 

Bank:................................................................            Branch:...........................................

 

 

 

Account No.:......................................................................................................................

 

 

 

Signed:.........................................................................Date..............................................

 

 

Please return to:-      Membership Secretary,  Bustia 182,  Credit Andorra - La Massana

 

 

 

 

 

 

 

                   

Club Internacional D’Andorra

       

                          AUTORITZACIO DE DOMICILIACIO BANCARIA

 

Per la present autoritzo el pagament de la meva subscripcio anual al Club Internacional D’Andorra, a carrec del compte seguent:

 

 

Nom:....................................................................................................................................

 

 

Banc:...................................................................    Oficina: ..........................................

 

 

Compte No: .......................................................................................................................

 

 

 

Signatura:............................................................     Data: ..............................................

 

                                Membership Secretary,  Bustia 182, Credit Andorra - La Massana

 

 

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