Gift Form
From: (Mr/Mrs/Ms/Miss/Other) 
Address: 
 Postcode: 
Please complete your name and address or telephone your credit card gift to 01444 457080
I would like to support IMPACT's work against needless disability. Here is my gift of £ 
I wish to donate by debit or credit card: Mastercard/Visa/Visa Debit/Barclaycard/CAF card
Debit/Credit Card No.:
Security Code:  (3 digit number on the reverse of the card, on the signature strip)
Expiry Date:  /   Telephone No*.: 
I wish to donate by cheque or postal order.

Please make your cheque or postal order payable to "IMPACT Foundation" and send it, with this form, to the address below.
Gift Aid: (please tick one box)

 I am a UK tax payer and I wish all donations I have made to the IMPACT foundation in the last four years and all donations I make hereafter to be treated as Gift Aid donations

or

 I am not a UK tax payer
I am a UK taxpayer and I understand that if I pay less Income and /or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in the relevant tax year (6th April to 5th April), it is my responsibility to pay any difference.

Please notify IMPACT if you:
Want to cancel this declaration / Change your name or home address / No longer pay sufficient tax on your income and/or capital gains.
If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self Assessment tax return or ask HM Revenue and Customs to adjust your tax code.
Please send me more information about:   IMPACT   Leaving a Legacy
Signature:  Today's Date  /   / 
Please return this form to:
Mrs. Judi Stagg, Chief Executive, IMPACT, 151 Western Road, Haywards Heath, West Sussex, RH16 3LH, UK.
Registered Charity No. 290992
Thank you

* For your security, we may need to telephone you to confirm your credit card gift.

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