Ad Hoc Donation Form

Crouch End Chavurah Donation Pledge Form

Your name *

First name

Last name

Your address *

House name or number

Address line 1

Address line 2

Address line 3

Address line 4

City

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Postcode

Email address *

Are you a CEC member? *

I am a current member

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Mobile phone

Donation *

Total amount

Is there a particular reason you are donating at this time?

Please tick the gift aid box below if you are UK tax payer.

By ticking this box I confirm that I am a UK Income or Capital Gains taxpayer. I have read this statement and want the charity to reclaim tax on the donation detailed on this form, given on this date. I understand that if I pay less Income Tax / or Capital Gains tax in the current tax year than the amount of Gift Aid claimed on all of my donations it is my responsibility to pay any difference. I understand the charity will reclaim 25p of tax on every £1 that I have given.