| STANDING ORDER FORM |
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| If you would like to make a regular donation to the Child Poverty Action Group, 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. | |
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| Forename | |
| Surname | |
| Address(1) |
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| Address(2) | |
| Postcode |
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| Telephone |
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INSTRUCTION
TO YOUR BANK/BUILDING SOCIETY |
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| To
the Manager |
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| Address(1) | |
| Address(2) | |
| Postcode | |
| Sort Code | |
| Name(s) of account holder(s) | |
| Your account number | |
| Please pay the Child Poverty Action Group the sum of £ per month quarter year (please select as appropriate) until further notice. | |
| Starting on (date) | |
| Your signature | ___________________________________ Date _________ |
| The
Child Poverty Action Group bank details are: Lloyds TSB Bank plc, 22/24 Southampton Street, London, WC2E 7JB Account No: 0423567; Sort Code: 30-92-32 |
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 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. |
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We hold your
details on our database to keep you informed of CPAG activities.
Tick here if you prefer not to be contacted.
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| 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) |
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