Please
print out this form and either post or fax it to CPAG. You can complete
the form on-screen and then print it out and sign it, or print out
the blank form and then complete it, whichever you prefer.
I would like to support the
work of the Child Poverty Action Group and enclose a donation of
£
I enclose a cheque/PO (cheques
made payable to 'Child Poverty Action Group' )
Credit/Debit cards: I wish to
pay by (please tick)
Visa
Mastercard
Delta
Switch
CAF
and authorise you to debit my credit/debit card account
Number
Expiry
Issue No or start date (Switch
only)
Signature
Name
Organisation
(if applicable)
Address(1)
Address(2)
Postcode
Telephone
Fax
Email
Use Gift Aid
and you can make your donation worth more. For every pound you give
to us, we get an extra 28 pence from the Inland Revenue. Please
select one of the buttons opposite.
Yes, please treat all my donations from 6 April 2000 and
until further notice as GIft Aid. I confirm I pay an amount of income
tax/and or capital gains tax at least equal to the tax that CPAG
will reclaim on my donations in the tax year.
No, I do not pay income tax or capital gains tax
in the UK.
I am unsure of my tax status.
I would prefer not to make a Gift Aid declaration.
We hold your
details on our database to keep you informed of CPAG activities.
Tick here if you prefer not to be contacted.
THANK YOU
Please
return to: Child Poverty Action Group, 94 White Lion Street, London
N1 9PF
Tel 020 7837 7979. Fax 020 7837 6414 Child Poverty Action Group is a registered charity (numbers
294841/SCO39339)