Standing Order Form

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Yes, I wish to give a donation by Standing Order direct from my bank account to
Wirral Donate and for the gift to be credited with Gift Aid (if applicable).

Surname:............................................................. Initial/s:........................

Title: Mr, Mrs, Miss, Ms (please delete)

Home address: ........................................................................................

...............................................................................................................

Post Code:......................................Tel No:..............................................

Email:.......................................................................................................

 

Account to be debited

 

Bank Details

Name and Branch:...................................................................................

Address:..................................................................................................

Post Code:......................................... Tel No:..........................................

Account Name:........................................................................................

Date of initial payment:.............................................................................

Monthly payment date:.............................................................................

Date of final payment (if any):...................................................................

 

 

 

Account to be Credited

Name and Branch: Natwest Bank, Neston

Account Name: The Wirral Donate Fund

Account Number: 59056029

Sort Code: 64-14-39

Authorisation to deduct (for Bank)

Total to be deducted per month:

Amount in Words:............................................................

Amount in Figures: £.........................................................

Signed:......................................................................................................

Print Name:...............................................................Date:........................

 

Gift Aid Declaration (for Inland Revenue)

If you are a tax payer and would like your donation to be increased by
Gift Aid paid direct to Wirral Donate please sign the declaration below.

I confirm that I am a tax payer and would like my donation to be credited with gift aid:


Signed:……………………............

Please photocopy this form and send a copy to your bank
and the original form to Wirral Donate at this address:

Mr R Collings (Secretary to Wirral Donate)

Devonshire Resource Centre
141 Park Road North
Birkenhead
CH41 0DD

 

 

For the purposes of the Data Protection Act 1998

The data supplied on this form will be used to enable your donation to reach
your chosen charity, Wirral Donate. In order that your instructions can be
acted on, your details will be passed to Her Majesty’s Revenue & Customs,
who will forward the Gift Aid of your donation to Wirral Donate.

Wirral Donate may send you a thank you letter acknowledging your donation.
If you do not wish to receive acknowledgement from your charity and only wish
to be contacted in the event of a specific query needed to resolve the processing
of your data for the purposes of these instructions, please tick here: