Standing Order

The easy way to make regular donations

Your details

Your full name (or name of business and address)

Bank and branch name and address

Postcode

Account Name: 

Account Number

Sort Code

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Standing Order Details

How often do you want the donation made?

Monthly    Quarterly    Half Yearly    Yearly

(please tick as appropriate)

Payment amount

£

Payment amount in words:

Payment reference (initials & surname)

First payment date _ _ / _ _ / _ _ _ _

Final payment date _ _ / _ _ / _ _ _ _

or until further notice (please tick)

Recipient 

Recipient’s name: The Rainbow Centre

Recipient’s account no: 03645356

Recipient’s bank : Lloyds TSB, Knowle

Recipient’s sort code: 30 94 83

Your Agreement 

I authorise you to debit my/our account, in accordance with the details above: 

Signature(s)

Date

Gift Aid Declaration

Gifts from UK tax-payers qualify for Gift Aid. By signing this declaration you are allowing the Rainbow Centre to reclaim the tax on your donations. You must pay an amount of income tax or capital gains tax equal to the tax we relaim and should notify us if these circumstances change or you change your address. You may cancel this declaration at an time.

I am a UK tax payer and I want the Rainbow Centre to reclaim the tax on all donations made by me since 6 April 2000 and hereafter (please tick box)

Signature:

Please return the completed form to:

The Rainbow Centre, 27 Lilymead Avenue, Bristol, BS4 2BY

Telephone: 0117 985 3343

Registered Charity Number: 1120461 and a company limited by guarantee registered in England number 6240935.

Formerly registered charity number 293570.