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Your Name

* First name

* Surname

Personal Details

* Email

* Re-enter email

* Home Address

* Line 1:

Line 2:

Line 3:

* Town / City:

County:

* Postcode:

Country:

Gift Aid

All payments are eligible for Gift Aid.

United Church Ferndown can reclaim the tax paid on this donation. Please remember that you must pay an amount of income tax and/or capital gains tax equal to the tax that is reclaimed for this donation.

I would like United Church Ferndown to reclaim tax on all donations associated with this Payment Group Registration.

I do NOT want United Church Ferndown to reclaim tax on this donation.

Payment Details

Give this card a name for future reference

* Cardholder Name (As printed on the card)
* Card Type
* Card Number
* Expiry Date	/
* Security Code (the last 3 digits on the back of your card. show me)	Please enter digits only.
Start Date (optional: please add if printed on your card)	/
Issue Number	(Maestro/solo only)

Cardholder Address

* Line 1:
Line 2:
Line 3:
* Town / City: * City:
County: State:
* Postcode: * Zip code:
Country:

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