Box Donation Application

RSPCA Hull and East Riding Standing Order Form
Branch/Centre and Registered Charity Number
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.Format: 00000000000.
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.
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
Date

MonthDayYear
Date
Should be Empty:

RSPCA Hull and East Riding Standing Order Form