I’d like to help with a gift today


1 Your details Title:


Forename:


Surname: Address:


Please send the completed form back to us to: Freepost, Helen & Douglas House, 14a Magdalen Road, OX4 1RW. Thank you for your support!


Email:* Telephone:*


* Please complete if you are happy to receive phone calls and/or emails from Helen & Douglas House about our work


Postcode:


2 Make a regular gift I wish to make a regular donation of:


£5 £10 Other £


Make your donations go further – a Gift Aided monthly gift of £10 is worth £12.50 to us; an extra £30 every year, at no extra cost to you! Please sign up below.


Monthly/Quarterly/Annually* starting on 2nd/15th* of


*delete as applicable Month


INSTRUCTION TO YOUR BANK OR BUILDING SOCIETY TO PAY BY DIRECT DEBIT


Please send this completed instruction to: Helen & Douglas House, 14A Magdalen Road, Oxford OX4 1RW


Bank/Building Society Account No.


Branch Sort Code


3 Make a donation I wish to make a donation of:


£


Please send a cheque/postal order/Charity Voucher made payable to Helen & Douglas House to: 14A Magdalen Road, Oxford OX4 1RW


OR charge my Visa


CharityCard Mastercard Switch/Maestro


Card Number Valid From Expiry Date Issue No.


(Switch/ Maestro)


Security No. Year


We would like to keep you up to date with our work and fundraising activities by post. If you would rather not receive this information, please tick this box


Name and full postal address of your Bank/Building Society


To: The Manager Address


Postcode


Service User Number Instruction to your Bank or Building Society


6 8 9 9 0 4


Please pay Helen & Douglas House Direct Debits from the account details in this instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain within Helen & Douglas House and if so, details will be passed electronically to my Bank/Building Society.


Signature Date


4 Gift Aid


Boost your donation by 25p of Gift Aid for every £1 you donate


Gift Aid is reclaimed by the charity from the tax you pay for the current tax year. Your address is needed to identify you as a current UK taxpayer. I want to Gift Aid this donation and any donations I make in the future or have made in the past 4 years to Helen & Douglas House. I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference.


Signature: Date:


www.helenanddouglas.org.uk


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