Hillingdon, Slough, Windsor, Kingston & District Branch Registered charity no 263515

Safe Haven Standing Order Form

Name: …………………………………………………………………………………………………………...………

Address: ………………………………………………………………………………………………………...……….

…………………………………………………………………….…… Postcode: ……………………………………

Tel No: ………………………………………Email: ……………………………………………………………...

Standing Order

To Bank / Building Society: ……………………………………………………………………………………………

Address: ……………………………………………………………………Postcode: .……………………………...

Account No: ……………………………………………………….…. Sort Code: …………...…………………..….

Name(s) of Account Holder(s): .. ……………………………………………………………………………………..

I would like to help sick and neglected animals, please accept my monthly gift of (please circle):

£3 per month£5 per month £10 per month Other Amount £ ……... (minimum £36 per year)

until further notice and debit my account starting on the ……………..….(date) and each month thereafter.

Signed: ………………………………………………………………………………….

Date: ……………………………………………………………………………………

From time to time, RSPCA may wish to send you news of offers and services that might be of interest to you. Please tick if you do not wish to receive these

Gift Aid Declaration
I am a tax payer and I want the Hillingdon, Slough, Windsor, Kingston and District RSPCA to treat all my donations as Gift Aid donations.
Signed: ………………………………………………………………………….. Date: ………………..………………………...
Notes:
  1. To reclaim tax on your donation, you must be paying income or capital gains tax, equal to the amount we reclaim.
  2. If your circumstances change and you no longer pay tax or capital gains you should cancel your declaration by notifying us.

DATA PROTECTION CONSENT

RSPCA Hillingdon, Slough, Windsor, Kingston & District Branch would like to contact you with further information about our future activities. Please tick the box if you want to receive updates and information about our future activities and ways in which you can help the RSPCA by post  and/or email 

Your information will NEVER be passed to any 3rd parties by us. However, in order to send you ANY information at all (Branch events, current appeals, etc) we MUST have your expressed permission first. PLEASE tick these boxes. You can notify us at any time if you wish to stop receiving information from us by emailing or by sending a letter by post.

Bank use only -

Please pay:Account: RSPCA Hillingdon, Slough, Windsor

& District Donation Account

Account No:

Sort code:

Please return this completed form to the Branch at: 16 Crescent Parade, Uxbridge Road, Hillingdon, Middlesex UB10 0LG