Authorisation (SEPA)

By signing this form, you lend your permission to the treasurer of ERC’69
to send yearly direct debit orders to your bank so that the bank can debit the amount for your dutch rugby union player card.
to send monthly direct debit orders to your bank so that the bank can debit the monthly contribution to our club.
Authorisation*
- Yes, I agree with direct-debit on my bank account by ERC '69
Name*

The name of the member(s) of ERC '69
IBAN account*

The bank account which will be charged
Bank account holder*

The holder of the IBAN bank acccount
Date*
DD slash MM slash JJJJ
City*
Signature*

Footer