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I would like to donate: £5 On 1st of each month
Name: Address:
Town/City: County:
£12 £20 15th of each month
My choice of
www.stjh.org.uk/nurse
By giving a regular gift, you will make a difference to our patients and families. We will keep in touch with news of our work, fundraising activities and how you can get involved. If you prefer not to hear from us by post, please tick here n.
For more information about how your personal information is used please visit
www.stjh.org.uk/privacypolicy
Charity No. 1113125
Postcode:
£
Instruction to your Bank or Building Society to pay by Direct Debit
Please fill in the whole form and send to: St Joseph’s Hospice, Mare Street, Hackney, London, E8 4SA
Name and full postal address
of your Bank or Building Society
Name(s) of Account Holder(s)
Originator’s Identification Number Reference (for office use only)
Instruction to your Bank or Building Society
Please pay St Joseph’s Hospice Direct Debits from the account detailed in this instruction subject to the safeguards assured by the
Direct Debit Guarantee. I understand that this instruction may remain with St Joseph’s Hospice and, if so, details will be passed electronically to my bank/building society.
627874
To: The Manager Bank/Building Society
Address
Postcode
Bank/Building Society Account Number
Branch Sort Code
Banks and Building Societies may not accept Direct Debit instructions for some types of account.
Signature(s)
Date
SPN_NL