Small Change for Big Changes
The British Stammering Association Supporters Club

Please print off this form, complete the details of yourself and your bank, and return it duly signed to: BSA, 15 Old Ford Road, London E2 9PJ. (Please do not try to email it.)

Standing Order Form

Please pay to CafBank Ltd (40-52-40), Kings Hill, West Malling, Kent, ME19 4TA, for the credit of the British Stammering Association (Account No. 00008336) the sum of

.... £3.90 (becomes £5 a month with Gift Aid*)

.... £7.80 (becomes £10 a month with Gift Aid*)

.... other: £.........................................................[figures then words]
   (any amount, no matter how small, will help us to carry out our work)

on the ..... day of ..................20...... [please insert the first day of payment] and the like sum on the same day of every month, until this order is cancelled in writing, charging such payments to my/our

Account No: ........................................ Sortcode:...............................

Name and address of your bank:..............................................................

........................................................................................................

........................................................................................................

Signature:...............................................Date...........................

Title First Name(s) Surname

Address:

Postcode:

*Gift Aid

If you are a taxpayer, your donation can be increased by more than 28% - your £3.90 or £7.80 would become £5 or £10 respectively to BSA at no cost to yourself. All you need to do is tick the Gift Aid declaration below.

.... I want the British Stammering Association to reclaim tax on all donations I make from the date of this declaration and all donations I have made in the six years prior to this date (but no earlier than 6/4/2000).

You must pay an amount of income tax and/or capital gains tax equal to the tax we reclaim on your donations (including any BSA membership subscriptions).

The British Stammering Association is a company limited by guarantee registered in England No. 4297778.
Registered Office: 15 Old Ford Road, London E2 9PJ.
Registered Charity Nos: 1089967/SC038866        First registered 1978.

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