Standing Order Mandate Form.



Please print this form, complete it then post it on to us at the address at the bottom of this page. Thank you for your support!

Your Details

Name:

  

Address:

 

 

 

Post Code:

  


Your Bank Address

Bank Name:

  

Bank Address:

 

Post Code:

  

Your Account Details:

Sort Code:

  

  

  

Account Number:

   


Please debit my account above the sum of (*circle as appropriate)
[£5  ]  [£10  ]  [£15  ]  [£20  ] or other amount £_______

Payment to be debited on the _____ day of each month, and monthly thereafter until further notice.


Please credit:   

Account Name:

Dunroamin K9 Rescue

Bank Address:

PO Box 8,  23 Bridge Street, Worksop Notts S80 1DR

Sort Code:

40-47-21

Account No:

4143_______________

Reference:

(*)

  (*) If sponsoring one of our Dunroamin dogs please enter the dog name as a reference,

Otherwise would you kindly add your Surname, as this will help our administration. Thankyou.
Note: For security reasons the last four digits of our account number will be added by us when we receive the completed form via post.

Signed:____________________    Dated:___________

Gift Aid – If you are a taxpayer ,for every £1 you donate we can claim an extra 28p from the taxman. All you need to do is check the box next to the declaration below. 

Gift Aid  □  (Please tick this box if you are eligible to pay Gift Aid)

‘I would like Dunroamin K9 Rescue to reclaim tax on all donations I have made since 1st May 2008 and all future donations until further notice,at no extra cost to myself’.
In order for Dunroamin K9 Rescue to reclaim tax you have paid on your donation(s), you must have paid income or capital gains tax (in the UK) equal to the tax that will be claimed from the Inland Revenue (currently 28p for each £1 you donate)

Please return this form to: Dunroamin K9 Rescue, 18 Thornhill Road, Harworth, Doncaster DN11 8LQ.