|
STANDING
ORDER 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.............................................................................................. |
............................................................................................................
|
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.
|
PART
TWO
|
|
| I
would like to make a regular gift per month to
the CCA of: |
| [..]
£20 |
[..]
£15 |
[..]
£10 |
[..]
£5 |
Other
Amount £...... |
|
Bank
Sort Code ...........................
|
|
| To:
Manager (Branch Name and Address) ............................................ |
..........................................................
................................................ |
................................................
|
Post Code ........................ |
| |
|
Signature .....................................
|
Today's
Date ............................. |
| THANK-YOU |
|
For
Office Use Only:
To the Co-operative Bank, PO Box 250, Delf
House, Southway, Skelmersdale, WN8 6WT,
a/c65050309
Quoting our Ref:............... |
|
