PLEASE DONATE TO SELBY DISTRICT VISION

STANDING ORDER MANDATE

 

Text Box: To the Manager Name of Bank: Address Postcode

 

Please pay: LLOYDS TSB PLC, 5 MARKET PLACE, SELBY YO8 4NT

For the credit of: SELBY DISTRICT VISION

Charity Reg No: 700894

Sort Code 30- 17- 80 Account Number 00391815

 

Text Box: The sum of : (in words) ________________________________Pounds (£ ) On the______________ (day), _______________ (month), _______________ (year) And thereafter every month until further notice and debit my account accordingly.

 

Text Box: Name of account-holder to be debited: Account Number: Sort Code:

 

Signed: _____________________________ Date:___________________________

 

Text Box: Your Address: Tel Number: Email address:

 

 

 

I would like tax to be reclaimed on my donation under the Gift Aid Scheme. I am a UK tax payer and pay an amount of income tax and/or capital gains tax at least equal to the tax that can be reclaimed on my donation. Please tick.

 

YES  c            NO  c

 

 

Please call 01757 709800 if you have any queries.

When completed, please return to:

 

 Selby District Vision Unit 12, Prospect Centre, Prospect Way,

 Selby,

 North Yorkshire

 YO8 8BD                                                                                                                                                We will then send this form onto your bank.

 

Thank you.

 

Text Box: For office use only :

 

Make a photocopy for the standing orders folder

Send the original form to the bank

Text Box: Add name of donor to donor database If the donor wishes to be gift aided then ensure this info is recorded on the donor’s database.