Burrswood

Single Donation Form

Please fill in the form online and use the print button to print it out.
Then post it to us using the address below: Print Form

Burrswood,
Groombridge,
Tunbridge Wells,
Kent
TN3 9PY

Please indicate how much you would like to donate to Burrswood:

£ or another amount £

I would like to pay by:
Cheque / Postal Order (make payable to Dorothy Kerin Trust)
Credit / Debit Card

Credit / Debit Card:

Please tick appropriate card issuer:
Visa
Mastercard

Card Number: (no spaces)

Expiry Date: (MM/YY)

Signed:

Date:

Personal Details

Name:

Address (inc Post Code):

Phone Number: (including code)

Email Address:

Gift Aid Declaration

If you are a UK taxpayer we can reclaim the tax that you have paid on this donation.
You must pay an amount of income tax or capital gains tax equal to the tax we recliam on your donations.
Please complete the following and return it to us.

I (your name):

of (Address - inc Post Code)

All donations which I make to the Dorothy Kerin Trust (registered Charity Number 1095940) are, from the date of this declaration and until I notify you otherwise, to be treated as Gift Aid donations.

Signed:

Date: