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DEBIT
CARD FORM
Please
print out this page, fill out both parts 1 and
part 2 on this page and send back to: CCA,
Freepost RLTS-SCKB-JKXG, 4th Floor, 197/199
City Road, London EC1V 1JN.
Call 0207 490 4494 for assistance
You do not need to use a stamp.
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| PART
ONE |
|
Mr/Mrs/Ms ............... |
|
First Name .................................... |
Surname.................................................... |
Address.............................................................................................. |
............................................................................................................
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Phone no .................................... |
Mobile No .................................... |
E-mail ........................................................................ |
|
Gift Aid: I want the CCA to claim Gift Aid
on all donations I make from
the date of this decleration until I notify
the CCA otherwise. I pay and
have paid income or capital gains tax (in the
UK) equal to the tax
that CCA will reclaim [ ]
If
you are a standard-rate tax UK tax payer that
means for every pound you give, the CCA gets
an extra 28p from the Inland Revenue, helping
your donation go further.
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PART
TWO
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| [..]
Switch |
[..]
Maestro |
[..]
Solo |
[..]
Electron |
| I
would like to make a
one off grant of: |
| [..
] £100 |
[..
] £50 |
[..]
£30 |
[..]
£20 |
Other
Amount £..... |
|
| |
My Debit Card No: __ __ __ __ __ __ __ __ __ __
__ __ __ __ __ __
Valid From: ..................... Expiry Date
................. Issue No ............
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