Donate by Direct Debit If you are not the account holder, this is a business account or more than one person is required to authorise debits on this account, please use this direct debit form instead. Monthly Donation £5£10£25£50 Other Amount Your Choice* £ We can turn your £ into £at NO extra cost to you If you are a UK taxpayer, the Gift Aid scheme increases the value of your monthly donation by 25% without costing you a penny more. Yes, I want Norwood to benefit from Gift Aid on my donations If you click 'Yes' to Gift Aid, you confirm that you are a UK taxpayer and would like Norwood to treat all donations you have made in the past four years and all donations you make in the future as Gift Aid donations until you notify us otherwise. You understand that if you pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all your donations in the relevant tax year it is your responsibility to pay any difference. Please phone us on 020 8420 6970 if your details or tax status changes. Your Details Title Mr Mrs Ms Miss Other Title First Name* Last Name* Post Code Address Line 1* echo ; ?> Address Line 2 City* echo ; ?> County Country* Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cabo Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo (Democratic Republic of the) Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (Democratic People's Republic of) Korea (Republic of) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russia Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine UAE UK USA United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Post Code* Email* Phone Number * Name of account holder* Bank sort code* Bank account number* Take payment on* 1st 15th of each month Your first donation will be collected on your chosen monthly donation date. If your chosen date falls within 10 working days of completing this form your first donation will be collected the following month. Data protection You can trust us – we don’t sell, share, rent or give away your details. We would like to keep you updated about our work and other ways you can support Norwood. We’ll get in touch only using the ways you select below and you can unsubscribe at any time. I am happy to hear from Norwood by: Post Email Telephone SMS We want to communicate with you in the way that you prefer. You can contact us at any time to update your communication preferences by emailing supporter.care@norwood.org.uk or phoning 020 8420 6970. Accept Terms I agree to Norwood's privacy policy
Donate by Direct Debit If you are not the account holder, this is a business account or more than one person is required to authorise debits on this account, please use this direct debit form instead. Monthly Donation £5£10£25£50 Other Amount Your Choice* £ We can turn your £ into £at NO extra cost to you If you are a UK taxpayer, the Gift Aid scheme increases the value of your monthly donation by 25% without costing you a penny more. Yes, I want Norwood to benefit from Gift Aid on my donations If you click 'Yes' to Gift Aid, you confirm that you are a UK taxpayer and would like Norwood to treat all donations you have made in the past four years and all donations you make in the future as Gift Aid donations until you notify us otherwise. You understand that if you pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all your donations in the relevant tax year it is your responsibility to pay any difference. Please phone us on 020 8420 6970 if your details or tax status changes. Your Details Title Mr Mrs Ms Miss Other Title First Name* Last Name* Post Code Address Line 1* echo ; ?> Address Line 2 City* echo ; ?> County Country* Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cabo Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo (Democratic Republic of the) Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (Democratic People's Republic of) Korea (Republic of) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russia Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine UAE UK USA United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Post Code* Email* Phone Number * Name of account holder* Bank sort code* Bank account number* Take payment on* 1st 15th of each month Your first donation will be collected on your chosen monthly donation date. If your chosen date falls within 10 working days of completing this form your first donation will be collected the following month. Data protection You can trust us – we don’t sell, share, rent or give away your details. We would like to keep you updated about our work and other ways you can support Norwood. We’ll get in touch only using the ways you select below and you can unsubscribe at any time. I am happy to hear from Norwood by: Post Email Telephone SMS We want to communicate with you in the way that you prefer. You can contact us at any time to update your communication preferences by emailing supporter.care@norwood.org.uk or phoning 020 8420 6970. Accept Terms I agree to Norwood's privacy policy