Claridge House - Donation Form

Claridge House - Donation
Print this form, or download and print the PDF version, fill it in and send it with your donation to:
Claridge House, Dormans Road, Dormansland, LINGFIELD, Surrey RH7 6QH
(Tel: 01342 832150)

Name:

Address:

Post Code:

Telephone:

E-mail:

I/we would like to give:- (please tick as appropriate)

A monthly donation by standing order

£5 £10 £25 £50 £100 Other (please state) £_____

Standing Order Instruction

Bank Name:

Address:

Post Code:

Sort Code:

Account No:

Account name:

Please pay to Claridge House on the ...... day of each month the amount indicated above

A one-off donation

£25 £50 £100 Other (please state) £_____

Payment can be made by cheque payable to 'Claridge House', or by Credit/Debit card using this form

Card Type:

Visa

Mastercard

Switch

Card No:

Expiry Date:

Issue Number (Switch only):

Name (as printed on card):

To leave a legacy - please send details

Signature:

If you pay UK tax you can make this and any subsequent gifts to Claridge House worth almost 30% more - at no extra cost to you. Simply tick and sign your name in the box to enable us to claim back tax already paid out on your gifts. Thank you

I want Claridge House to treat all donations I have made for the six tax years prior to the year of this declaration, and any in the future, as Gift Aid donations until further notice

Signature:

Date:

N.B. This declaration enables us to reclaim 28p for every £1 you give. You must pay an amount of income tax or capital gains tax at least equal to the tax that we reclaim on your donations in the appropriate tax year. If you have already signed a Gift Aid declaration, thank you, your gift is already worth 28% more.