SAVANA

Standing Order Mandate Form

 
 I wish to make a contribution to Savana in the form of
 

 A monthly Standing Order of:  £ ………………………./month - please specify

Signature ………………………………………………………………………..Date …………………………………….

 

Please complete Standing Order Mandate

below and return to
 

 

Savana, Dudson Centre,

Hope Street, Hanley, Stoke-on-Trent ST1 5DD

 

GIFT AID DECLARATION

 

Thank you for your generous support. If you pay basic rate income tax we can reclaim the tax on your donation. Please sign the Gift Aid Declaration below if you are able and then any charitable donation made to the Savana in future will be tax efficient.

"I am a UK taxpayer. Please reclaim the tax on all my donations to the Savana (Charity no. 701540) from 6 April 2007 and any I make in the future, until I notify you otherwise. I will advise you if I cease to be a taxpayer, and of any changes to my name and/or address." 

Signature .............................................................................................   Date......................................................

 

STANDING ORDER MANDATE

To the Manager of ............................................................................................................Bank plc     

 

Address of bank ..............................................................................................................................................

 

.............................................................................................................................................................................

 

Sort Code:          

Account No: 

Please pay to the current account no. 2613584 of Savana at Lloyds TSB Bank, Fountain Square, Hanley, Stoke on Trent, ST1 1LE  (Sort code 30-93-83) the sum of     

£............................ on the ............................. day of ..............................................................    200 ...... 

 

and thereafter make monthly payments of £ ...............  until further notice

 

Name ........................................................................................... Address .....................................................

 

..............................................................................................................................................................................

 

............................................................................................           Date .........................................................

 

Signature ................................................................................................................... 

This standing order supersedes any existing mandate payable to Savana

 

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Last Modified 2008-08-17