Donation form Your details Title:
First name:
Surname:
Address: Postcode: Phone:
Email:
Your donation Donation amount:
Cash:
Cheque:
Card:
Please make cheques payable to St Richard's Hospice or enter your debit or credit card details below:
Reason for donation:
Mastercard:
Visa:
Switch:
CAF:
Card Number: Valid From:
/
Expiry Date:
/
Card holder's name:
3 digit security no:
Card holder's signature:
We do not store card details nor do we share your financial details with any third parties outside of essential processing
Keeping in touch From time to time we would like to keep you up to date with our Hospice news. Please fill in the details below so we can ensure we give you the information you want. I am interested in receiving information about: Hospice Updates:
Volunteering Opportunities:
Courses and Conferences:
Please let us know ways we can contact you by ticking the relevant options: Email:
Post:
SMS:
Phone:
No contact:
Gift Aid Make your donation worth more at no extra cost... All we need from you is to sign the declaration. I am a UK tax payer and would like St Richard’s Hospice to reclaim the tax on any of the donations I have made in the last 4 years and any future donations I make. (To qualify for Gift Aid, you must pay an amount of UK Income Tax and/or Capital Gains Tax at least equal to the tax to cover all charitable donations and that other taxes such as council VAT do not qualify).
Signed:
Date:
St Richard’s Hospice Foundation • Wildwood Drive • Worcester • WR5 2QT Telephone 01905 958262 • Email: appeals@strichards.org.uk • Website: www.strichards.org.uk Charity No 515668 • Registered Company No. 01850502
St Richard’s Hospice is largely dependent on voluntary donations and gifts in Wills