Box Donation Application

RSPCA Hull and East Riding Standing Order Form
Branch/Centre and Registered Charity Number

RSPCA Hull and East Riding Branch CIO - Charity Number 1209420
About you.
Name

PrefixFirst NameLast Name
Address*

Street Address Line 1

Street Address Line 2

City

Postal Code
Phone
Please enter a valid phone number.
Email*
example@example.com
We'd love to keep you updated via email about our fundraising activities, products and ways you can support us to help animals.
Your Bank Name
Your Bank Address
Your Account Number
Your Sort Code
The amount of £ blanks monthly starting on Date and each month thereafter until further notice.

(N.B please date at least once month later than today's date.)
Gift Aid- Please allow the RSPCA Hull and East Riding Branch to boost your donation by 25p for every £1 you donate.

Yes, I want to Gift Aid any donations I make in the future or have made in the past four years. I am a UK tax payer 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.No, I am NOT a UK tax payer.
Date

MonthDayYear
Date
BANK USE ONLY

Please pay to RSPCA Hull and East Riding Branch at:

BARCLAYS

Account Number: 43372804

Sort Code: 20-43-47

Reference: RSPCA Hull Friend
Signature

Powered by Jotform SignClear
Date

MonthDayYear
Date
Should be Empty:

RSPCA Hull and East Riding Standing Order Form