| STANDING ORDER FORM |
|---|
| To the Manager Bank |
| Branch Address: |
| Postcode: |
| Please pay the IMPACT Foundation |
| (Account 60171913 Barclays Bank Plc, Lewes Group of Branches, 204976) |
| £ Each year/quarter/month starting on the / / until further notice. |
| My account number is: My Sort Code is: |
| Name: |
| Address: |
| Postcode: |
| Signed: Date: / / |
Please return to: Mrs. Claire Hicks, Chief Executive IMPACT, 151 Western Road, Haywards Heath, West Sussex, RH16 3LH, UK. If you are a UK taxpaxer please also complete and return a Gift Aid Declaration to enable us to reclaim tax on your donation. Click here for a Gift Aid Declaration. Registrered Charity No. 290992. |
| Thank you |