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iCard Request Form
iPayments
2020-04-27T15:09:03+00:00
iCard Request Form
Use below or email a list to
iCard@iPaymentsCentre.ie
including
School and roll number
Name, DOB & mobile number for each iCard holder
iCard Request Form
How many cards do you require?
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
School Name & Address
School Roll Number
Card 1
Name
*
Full Name
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 2
Name
*
Full Name
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 3
Name
*
Full Name
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 4
Name
*
Full Name
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 5
Name
*
Full Name
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 6
Name
*
Full Name
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 7
Name
*
Full Name
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 8
Name
*
Full Name
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 9
Name
*
Full Name
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 10
Name
*
Full Name
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 11
Name
*
First
Last
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 12
Name
*
First
Last
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 13
Name
*
First
Last
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 14
Name
*
First
Last
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 15
Name
*
First
Last
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 16
Name
*
First
Last
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 17
Name
*
First
Last
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 18
Name
*
First
Last
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 19
Name
*
First
Last
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 20
Name
*
First
Last
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
Card 21
Name
*
First
Last
Date of Birth
*
Date Format: MM slash DD slash YYYY
Mobile
*
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