Burrswood

I / we would like to support The Burrswood International Fellowship.

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

Credit / Debit Card:

Please tick appropriate card issuer:
Visa
Mastercard

Card Number: (no spaces)

Expiry Date: (MM/YY)

Signed:

Date:

Banker's Standing Order

To: (Name & Address of your Bank / Building Society - please include the Postcode)

Bank Account No.

Please Pay:
HSBC, 105 Mount Pleasant, Tunbridge Wells, Kent TN1 1QP
for the credit of The Dorothy Kerin Trust
Account No: 31686402, Sort Code 40-44-37
the sum of £ on the 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st Day day of January February March April May June July August September October November December Month , of the 2008 2009 2010 Year , and every month quarter year Regularity thereafter.

Signed:

Date:

Personal Details

Name:

Address (inc Post Code):

Phone Number: (including code)

Email Address:

Signed:

Date:

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: