Dementia Diamonds

Dementia Diamonds Regular Donations

Dementia Active Charity (no: 1195246)
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
I want to donate £3.00 per monthI want to donate £9.00 per monthI want to donate £33.50 per monthI want to donate £45.50 per monthI'm sorry I can't help at the momentOther
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. In order to Gift Aid your donation you must tick the box below:*

I want to Gift Aid my donation to Dementia Active (Charity no. 1195246). I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all my donations it is my responsibility to pay any difference.I am not able to Gift Aid at this time.
Direct Debit and GoCardless
GoCardless is the UK’s leading Direct Debit provider and is used by over 2,000 organisations. GoCardless is sponsored by RBS and is authorised by the FCA. The Direct Debit Guarantee makes this the safest way to pay.
Recommended way to pay, tick to pay via direct debit. Before submitting this form you will be asked for your bank details. (There are other ways to pay on the next page of this form).

'Go Cardless' direct debit

Other ways to pay

Bank transfer. Account name:- Dementia Active. Sort Code:- 40-52-40. Account no:- 00034684Cash or Cheque

Dementia Diamonds Regular Donations