Banker's Order Form

Please complete form, print & send, along with your donation, to:

Community H.E.A.R.T.
UNISON Manchester
3/5 St John Street
Manchester, M3 4DN
Tel: 0161 254 7505
Fax: 0161 254 7515

You can print out the form and then fill it in by hand
OR fill it in online and then print it out.

If you would like your donation to go towards a particular project, please specify here.
Otherwise, Community H.E.A.R.T. will use your contribution where it is most needed:

Project Name:

Donor Details:

Donor Name:
Address:
Postcode:
Tel:
Fax:
Email:

Bankers Order:

I/We ____________________ of the above address hereby make a standing order of

£
(SELECT MONTHLY, QUARTERLY OR ANNUALLY)

to Community H.E.A.R.T.
(Registered Charity No. 1052817)

Starting on: (Day/Month/Year)

until further notice, using my name as reference.

Until further notice at:
HSBC
40 - 03 - 33
A/C 11177516

Donors Bank:

Name:
Bank Address 1:
Bank Address 2:
Post / Zip Code:
Country:
Bank A/C No:
Bank Sort Code - -

GIFT AID DECLARATION
(PLEASE CHECK BOX)
As a UK taxpayer, I want Community H.E.A.R.T. to treat all donations I make on or after 6th April 2000 as Gift Aid donations until I notify you otherwise.

SIGNATURE:

Date: (Day/Month/Year)