Pound-Age

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Pound-Age Giving Form - (Please Consider Gift Aid)

First Name

Last Name

Address 1

Address 2

City

Zip / Post Code

I confirm that I would like Age Concern to treat all donations I have made and will make until I notify you otherwise, as gift aid donation. I confirm I pay an amount of income tax and / or capital gains tax at least equally to the tax that the charity reclaim on my donations in the tax year.

Standing Order Mandate

Name of Bank

Bank Address

Sort Code

Account Number

Bank Account Name

Please pay to the account of Age Concern Colchester the sum of (figure in £'s):-

Until further notice

Date of First Payment

First Name

Last Name

Address 1

Address 2

City

Zip / Post Code

Date

Beneficiary Details Co-Operative Bank Plc, PO Box 250, Delf House, Southway, Skelmersdale, WN8 6WT

Sort Code 08-92-99

Account Number 65487930

Account Name Age Concern Colchester

Age Concern Colchester is a registered charity (1142414) and company limited by guarantee. Registered in England and Wales

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Pound-Age

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