Aff Cath Online Regular Donation Form

Title

Full Name*

First NameLast Name

Company

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

Mobile Number

Diocese

E-mail*

Receive our email newsletter

Yes

By giving us your postal address, email address and/or your telephone number, you agree that we may use it to send you information about our work, fund raising and other activities by email and/or SMS. We would like to keep you up-to-date with our work and other activities.

Opt in to AFF CATH communications

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Gift Aid Declaration

I would like my donation to quality for Gift Aid

By selecting the Gift Aid box you agree to the following: I declare that I wish this donation made by me to (Registered Charity no. 1007291) to be treated as Gift Aid donation and for the charity to be able to reclaim tax on the amount. I understand that in order to declare this donation as a Gift Aid I pay income tax or capital gains tax equal to the tax the charity is able to reclaim on these sums (currently 28 pence for every £ that I give).

Tax status*

I am a tax payerI am not a tax payer

MonthDayYear

Please select below the type of regular donation that you would like to make.

The first payment will be made on completion of this form and subsdquent payments wll be made every month or year until you cancel the agreement. AFF CATH uses WorldPay to set up regular donations. You may cancel anytime by logging into your WorldPay account. Details of which will be sent to you by email after completing the secure payment form. You will be taken to the WorldPay payment form once you have selected from the list below and clicked submit.

Registered Charity number 1007291.

Select your regular payment from the list below:

Aff Cath Yearly Payment(£12.00 for each year)

Aff Cath Yearly Payment(£30.00 for each year)

Aff Cath Yearly Payment(£50.00 for each year)

Aff Cath Yearly Payment(£100.00 for each year)

Aff Cath Monthly Payment(£2.50 for each month)

Aff Cath Monthly Payment(£5.00 for each month)

Aff Cath Monthly Payment(£10.00 for each month)

Regular Donations Form