Standing order form

Please complete this form, print it out, sign it and return to the address below

I wish to make a regular donation of

Each month Each quarter Annually
 For years Starting on            Until further notice

Title:
Full Name:
Address:
Postcode:
Telephone No:
Account Number:
Sort Code:
Name and address of your bank:
Postcode:
I wish all donations that I make under this standing order mandate and any other donation that I make to the Langford Trust for Animal Health and Welfare to be treated as Gift Aid Donations.  
NB: The amount of income tax or capital gains tax that you pay must be equal to the tax we reclaim on your donations/  please notify us if this is no longer the case.
Please pay to: The Langford Trust for Animal Health and Welfare
Registered Charity no 900308
HSBC, 16 Woodborough Road, Winscombe, North Somerset, BS25 1AD
Sort code 40-47-46 Acc no: 51071556

Signature

_________________________________

Date

________________
Please return this completed form to The Langford Trust, Langford House, Langford, North Somerset BS40 5DU, not to your bank. Thank you for your generosity.
Office Use Only: Please quote this reference when processing payment: wso07