Standing Order Form - Clevedon District printable pdf download

Standing Order Form - Clevedon District

Standing Order Form

To: (insert name and address of your bank) -----------------------------------

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Sort Code: _____/______/____

Account No: _____________________________

Please pay a regular gift of (tick appropriate box)

I wish to donate £ ________ (please also state the amount in words) __________________

each month to Clevedon and District Foodbank CIO

Please start on ___ / ___ / ___ and each month until further notice.

Signature: _________________________

Date: ______/________/20___

HSBC, Triangle Branch, 6 Old Church Road, Clevedon, North Somerset, BS21 7HE.

Sort code: 40/17/50

Account: 41477102

(Insert details of person setting up standing order below):

Title: (Mr/Mrs/Dr etc.) _______ Name: ____________________________________________

Address: _____________________________________________________________________

Post code: _________________

Phone: _____________________

Email: _________________________________

Tick the box to add an extra 25p to every £1 you give at no extra cost

Yes, I pay tax in the UK. Please treat all donations I make or have made to the (insert name of Foodbank or local

charity) for the past four years and for the future as gift aid donations until further notice.

(You must pay income tax/capital gains tax at least equal to the amount of tax reclaimed on your donations.)

Please send this form to Clevedon and District Foodbank CIO, 1 Neads Court, Knowles Road, Clevedon,

North Somerset, BS21 7XS. Registered charity number.

1163153

Standing Order Form - Clevedon District