Donation Form - Richmond House Social Care Services CIC Community Interest Company - Social Enterprise No 11154305 - VAT Registration Number 334 2361 28

Secure payments by

Amount

£00.00

Name *

First

Last

Email *

Tel. number

Reason of donation

About your donation: If you are a UK taxpayer, tick the Gift Aid box and increase the value of your donation by 25p for every £1 you give, at no extra cost to you.

Tick here to add Gift Aid and confirm the following statement

"I want to Gift Aid my donation and any donations I make in the future or have made in the past 4 years to Richmond House Social Care Services CIC. I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference." If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code. Please notify us if you: - Wish to cancel this declaration - Change your name or home address - No longer pay sufficient Income Tax and/or Capital Gains Tax

Card number *

Expiry month *

Expiry year *

YYYY

Security code *

The last 3 or 4 digits printed on the back of your card

Billing address *

Address *

Country *

United Kingdom, others

Postcode *

Is your home address the same as your billing address?