Direct Debit Please print out and complete the following form, and send it to Practical Action (see address below) Yes Supporter Number (if known) I want to give regularly to Practical Action and help people find simple, effective solutions to poverty. First name Surname Title Address Postcode How your information will be used: It is vital to our work with poor communities that we are able to communicate with our supporters. Practical Action holds the information you provide to enable us to process your gift and send you mailings about our work and how you can help. Please t ick the box if you would be happy to receive communications via email. If you would rather not hear from us please email supporterservices@practicalaction.org.uk, telephone free on 0800 389 1624 o r write to Supporter Services Unit, Practical Action, Freepost CV1753 Bourton on Dunsmore, Rugby CV23 9BR. From time to time we would like to share your information We will never supply your information to with organisations we think you might be interested in. If you would rather your name was not included please tick this box. a third party for marketing purposes if you tell us not to. Date Telephone Please pay Practical Action Preferred collection date E mail Per month 12th of the month Per quarter 25th of the month Per year Start date (Please tick) Give more at no extra cost to you Please tick here if you would like Practical Action to reclaim the tax on your donations. I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April to 5 April) tha t is at least equal to the amount of tax that all the charities or Community Amateur Sports Clubs (CASCs) that I donate to will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand the charity will reclaim 28p of tax on every £1 tha t I gave up to 5 April 2008 and will reclaim 25p of tax on every £1 that I give on or after 6 April 2008. Signature _____________________________________________ Date __________________________ Your declaration covers any donation you are kind enough to make to us in the future. Therefore please notify us if you chang e your name or address You can cancel this declaration at any time by letting us know in writing. You may need to do this if your tax status change s If you pay tax at the higher rate, you can claim further tax relief in your Self -Assessment tax return The tax reclaimed will be used to fund the whole of Practical Action’s work Instruction to your Bank or Building Society to pay by Direct Debit Please fill in the whole form and send to Practical Action, The Schumacher Centre , Bourton on Dunsmore, Rugby, Warwickshire, CV23 9QZ To: The Manager Address Bank/Building Society Server user number 41 Reference 7 06 5 This is not part of the instructions to your Bank or Building Society Postcode Name of Account Holder(s) Branch sort code FOR PRACTICAL ACTION OFFICIAL USE ONLY Instructions to your Bank or Building Society Please pay Practical Action Direct Debits from the account detailed in this instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with Practical Action and, if so, details will be passed electronically to my Bank/Building Society. Signature(s) Bank/Building Society Account Number Date Banks and Building Societies may not accept Direct Debit instructions for some types of accounts Practical Action is a registered charity and company limited by guarantee. Registered office: The Schumacher Centre, Bourton on Dunsmore, Rugby, Warwickshire, CV23 9QZ, UK Patron HRH The Prince of Wales, KG, KT, GCB | Registered Charity No 247257 | Comp Reg No871954, England Banks and Building Societies may not accept Direct Debit instructions for some types of account. This Guarantee should be detached and retained by the payer. The Direct Debit Guarantee This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits If there are any changes to the amount, date or frequency of your Direct Debit Practical Action will notify you 10 working da ys in advance of your account being debited or as otherwise agreed. If you request Practical Action to collect a payment, confirmation of the amount and date will be given to you at the time of the request If an error is made in the payment of your Direct Debit, by Practical Action or your bank or building society, you are entitl ed to a full and immediate refund of the amount paid from your bank or building society – If you receive a refund you are not entitled to, you must pay it back when Practical A ction asks you to You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be req uired. Please also notify us.
Practical Action,