Standing Order Form

Your personal details

Your First Name

Your Surname

Address Line 1

Address Line 2

Town/City

County

Postcode

Your email

Mobile phone number

Standing Order Payment

Frequency of payment
MonthlyQuarterlyAnnually

Amount of payment
£5£10£20£Other

Other Amount

Instruction to your Bank/Building Society

Bank/Building Society

Branch Address

Branch Postcode

Account Number

Account Sort Code

Please pay the amount of £ starting on and thereafter every MonthlyQuarterlyAnnually

Donation
Donation

Payment Reference (your name and dog’s name if sponsoring)

Signature
I authorise my bank/Building Society to set up a standing order to the Freedom of Spirit Trust for Border Collies

Date

Gift Aid declaration

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

Please notify FOSTBC if you:
• Want to cancel this declaration
• Change your name or home address
• No longer pay sufficient tax on your income and/or capital gains