7
Please return this form with your gift (if appropriate) in an envelope to:
Harlington Hospice Association, Lansdowne House, St Peter’s Way, Harlington UB3 5AB
or If you would like to make your donation over the phone, please call our main switchboard on 020 8759 0453 and ask for the fundraising department. You can also donate through our web site at www.harlingtonhospice.org
Registered charity No. 1099332
I pledge my support to the Harlington Hospice
Data Protection. If you are new donor and do not want us to put your record on our database and therefore receive no further information about the Harlington Hospice Association, please write to us with instructions.
1
By Switch
By CAF Card
By Credit Card
Signature:
2
My card details are as follows:
Name:
Card
Number:
Switch issue Number:
Valid from:
Valid to:
Date:
Address to which your card is registered, if different from the address given in section 1 above.
:
I would like to make a donation of £
By cheque or CAF voucher
(payable to Harlington Hospice Assoc.)
Bankers to Harlington Hospice Association:
Barclays Bank, Cardinal Point, Hounslow TW1 2AH
Account No: 70006343 Sort code: 20 38 83
Frequency: please tick as appropriate)
I would like to set up a standing order to support the Harlington Hospice Association
Name of
your bank:
Sort code:
Account
Number:
Account
Name:
Amount you would like to pay: £
Monthly
Quarterly
Annually
Start date:
Signature:
Address of your bank: (inc. post code)
3
2005
I would like to giftaid all my donations from April 1st 2005 to enable the Harlington Hospice Association to reclaim 28p in each £1 I give. I confirm that I pay tax at the basic rate or higher.
Signature:
Date:
4
Telephone:
Email:
Address:
Post Code:
Name:
My details are as follows:
April 2005 Newsletter