Standing Order Online Application

ONLINE APPLICATION

On this form all mandatory fields (marked*) must be completed. If a field is not relevant to you then please enter NONE

Please do not use the 'RETURN' key when completing this form

Your Details

DIRECT DEBIT / STANDING ORDER MANDATE

Details of my Bank/Building Society with whom I have made arrangements for payments to be made to the ELMC

About the payment

How often are the payments to be made

MonthlyQuarterlyAnnuallySingle

(Note: Single Payment must be of £60 minimum to become a 'Friend')

Date and amount of first payment

Choose one of the following two options:

1) Date and amount of final payment

2) Until further notice
(payments will be made until you cancel this instruction)

Details of Account to which payments are to be made

Name: East Lancashire Masonic Charity

Sort Code: 20-74-45 Account Number: 33158985

I request that these donations be recorded in my name as a member of:

**Boost your donation by 25p of Gift Aid for every £1 you donate!**

GIFT AID DECLARATION

GIFT AID is claimed by the Charity from the tax you pay for the current tax year.

I want to Gift Aid my regular donation of:

and any donations that I make in the future or have made in the past 4 years to the East Lancashire Masonic Charity

I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on my donations in that tax year it is my responsibility to pay any difference.

IMPORTANT: BY ENTERING YOUR NAME BELOW YOU AGREE TO SIGNING DIGITALLY FOR SETTING UP GIFT AID

PLEASE ENSURE THAT YOU HAVE COMPLETED ALL REQUIRED FIELDS BEFORE SUBMITTING THIS FORM

**PLEASE REMEMBER TO MAKE THE STANDING ORDER / DIRECT DEBIT ARRANGEMENT WITH YOUR BANK IN ADDITION TO COMPLETING THIS FORM**