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Surname *
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VAT number
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E-mail *
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Address (street, square, number...)
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Address 2
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Post Code
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County - State
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Telephone 1
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Telephone 2
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Applies to: *
Director of the bank
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From this date onwards, please pay the bills of the associaton 'No Jubilem la Memòria'
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With this IBAN
IBAN of 24 digits
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