Direct Debit Form

Instructions to your Bank or Building Society to pay by Direct Debit

You can either sign up to pay Direct Debit online here or by post. You can download a Direct Debit form to print out and send to us directly. Download a Direct Debit form

Service user number: 962679

Note: Your account number and sort code will identify your bank and branch address.

Donate Direct Debit

Name *

Telephone

Email *

Address 1 *

Address 2 *

Postcode *

Because your support is so important to us, from time to time, we would like to keep in touch with you about our work. Please choose how you would prefer to receive this information. Please tick the appropriate box(es):

By mail

By telephone

By email

By SMS

You can update your communication preferences at any time by contacting our Donor Care Team on 028 9080 5599 or email info@cancerfundforchildren.com.

Payments will be taken from your account on the 1st of each month.
Instruction to your Bank or Building Society to pay by Direct Debit.

I would like to give a regular gift of

£3

£5

£10

Other

Other Amount

Bank Name

Name and full postal address of your Bank or Building Society

Bank Address 1

Bank Address 2

Bank Postcode

Name of Account Holder #1

Name of Account Holder #2

Bank/Building Society Account Number

Sort Code

Account Holder #1 Signature

Account Holder #2 Signature

Signature #1 Date

Signature #2 Date

Do you pay tax? If so, you can boost the value of your gift by 25p for every £1 you donate.

I am a UK Taxpayer. Please treat all donations I make or have made to Cancer Fund for Children for the past 4 years, and all future donations as Gift Aid donations until further notice. I understand that if I pay less Income Tax 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 dierence. I understand the charity will reclaim 25p of tax on every £1 that I have given.

Taxpayer #1 Signature

Taxpayer #2 Signature

Taxpayer #1 Date

Taxpayer #2 Date