SPONSOR AN ANIMAL SCHEME

I wish to sponsor:                                          (name of animal) for the sum of                                    per month/quarter/annum starting from

I am a tax payer: yes o           no o

I wish my contribution to attract Gift Aid o

Your name and address

Title:

Forename:

Surname:

Address:

Post Code:                                                               Phone:

Email:

Signature:___________________________________            Date:___________________________

PLEASE RETURN FORM TO:

JOHN ALLAN

SALTBURN ANIMAL RESCUE ASSOCIATION

PO BOX 69

BROTTON

SALTBURN-BY-THE-SEA

CLEVELAND

TS12 2GN

TEL: (01287) 201005

BANKERS STANDING ORDER

To:_____________________Bank/Building Society

Name of account to be debited:

________________________________________

Branch:____________________________________

Sort code (if known): £ £ - £ £ - £ £

Account Number: £ £ £ £ £ £ £ £

PLEASE PAY to Lloyds TSB, Redcar Branch, SORT CODE NUMBER 30-16-96

For the credit of SALTBURN ANIMAL RESCUE ASSOCIATION, ACCOUNT NUMBER: 0148058

The sum of £______________(figures)______________________________________(words) on the

________________day of_________________________20_____                                and a like sum

A

ANUALLY on the _________day of___________in each subsequent year until further notice

B

QUARTERLY on the___________day of each subsequent third months until further notice

C

MONTHLY on the _____________day of each subsequent month until further notice

Signed:_________________________________________

Date:___________________________

Name in BLOCK CAPITALS:______________________________________

NOTE:

This cancels existing standing order(s) for £__________after the payment made on ______________