Can you give a regular gift ?
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You can easily set up your regular donation in one of two simple ways !
1 . Visit www . acorns . org . uk / regular-giving to set up your regular donation online or
2 . Complete the form below and return it to
Acorns Children ’ s Hospice , Drakes Court , Alcester Road , Wythall , Birmingham , B47 6JR .
Please complete your details in the spaces below .
Title : Mr / Mrs / Miss / Ms : .............................. First Name : ................................................................. Surname : ............................................................................................
Address : ............................................................................................................................................................................................................................................................................... ............................................................................................................................................................................. Postcode : ............................................................................................. Daytime Tel ( inc . STD code ): ...................................................................... Evening Tel ( inc . STD code ): .................................................................................... Email : ................................................................................................................................................... Date of birth : ................................................................................... If you ' d like to hear more about Acorns by email please tick here I hereby certify I am over 18 years old ( please tick )
I would like to pay £ ......................... per month / quarter / year ( please delete as appropriate )
I would like my direct debit to start in ................................ ( specify month ) On the 2nd or 17th ( please specify ) of every month / quarter / year ( please delete as applicable )
Your kind donation to Acorns Children ’ s Hospice could be worth more without it costing you a penny ! Simply tick the relevant box below .
I want to Gift Aid * my donation and any donations I make in the future or have made in the past 4 years to Acorns I do not wish to Gift Aid my donation
Direct Debit Details
Gift Aid allows Acorns to claim an extra 25p For every £ 1 donated in the past 4 years and in the future
* I am a UK taxpayer and understand that if I pay less Income Tax and / or Capital Gains Tax than the amount of Gift Aid claimed on all of my donations in that tax year it is my responsibility to pay any difference . Please notify Acorns by calling 01564 825000 or emailing info @ acorns . org . uk if you wish to cancel this declaration , change your name or home address or no longer pay sufficient tax on your income and / or capital gains .
Instruction to your Bank or Building Society to pay by Direct Debit : Acorns Children ’ s Hospice Trust , Drakes Court , Alcester Road , Wythall , Birmingham B47 6JR .
To the Manager of ..............................................................................................................................................
............................................................................................................................... Bank / Building Society
Address .................................................................................................................................................................
Service users number
Reference number
9 7 3 0 0 9
........................................................................................... Postcode .............................................................. Name ( s ) of Account Holder ( s ).................................................................................................................... Bank / Building Society accoun t number
Branch Sort Code
Banks and Building Societies may not accept Direct Debit instructions from some types of account
INSTRUCTION TO YOUR BANK OR BUILDING SOCIETY - Please pay Acorns Children ’ s Hospice Trust 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 Acorns Children ’ s Hospice Trust and , if so , details will be passed electronically to my Bank / Building Society .
Signature ( s )................................................................................................................................................................. Date .........................................................................................
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 Acorns Children ’ s Hospice will notify you 10 working days in advance of your account being debited or as otherwise agreed . If you request Acorns Children ’ s Hospice 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 Acorns Children ’ s Hospice or your bank or building society you are entitled 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 Acorns Children ’ s Hospice asks you to .
• You can cancel a Direct Debit at any time by simply contacting your bank or building society . Written confirmation maybe required . Please also notify us .