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 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) that 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 IMPACT Foundation will reclaim 28p of tax on every £1 that 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.

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.

Print This Page   |   Close