Dental Appeal Form

Donation type: Dental Appeal
Mr / Mrs / Miss / Ms (delete as applicable) Your forename(s)  
Your surname:   Telephone no:  
Your address:  
 
  Your postcode:  
Email address (if you wish to be informed of Buttercups activites by email):  
Do you wish to donate by cheque (enclose a cheque payable to Buttercups Sanctuary for Goats) or by standing order (complete details below)?: Cheque / Standing Order

Standing Order Details (please complete if relevant)
Name of your bank:   Sort code of bank:  
Address of your bank:  
 
Postcode of bank:   Your account no:  

Instuction to bank - please pay: Buttercups Sanctuary for Goats, National Westminster Bank, 3 High Street, Maidstone, Kent, account number 83224394, sort code 60 60 08

The sum of £________ on the _______ day of ____________________ 200__ and afterwards on the same

day each month / year until further notice
Signed:   Date:  

Please print a copy of this form, complete it, and return to: Buttercups Sanctuary for Goats, Boughton Monchelsea, Kent, ME17 4JU

We can claim a further 28p in the pound from the Inland Revenue if you sign this as Gift Aid, provided you are a UK tax payer - I would like to treat all monies that I give from the date of this declaration until I notify you otherwise, as a Gift Aid Donation:
Signed:   Date: