|Standing Order Form|
|To the Manager Bank|
|Please pay the IMPACT Foundation|
|(Account 60171913 Barclays Bank Plc, Lewes Group of Branches, 204976)|
Each year / quarter / month (delete as appropriate)
starting on the / / until further notice.
My account number is:
My Sort Code is:
|Signed: Date: / /|
Please return to:
Mrs. Judi Stagg, Chief Executive
IMPACT, 151 Western Road, Haywards Heath, West Sussex, RH16 3LH, UK.
Registered Charity No. 290992.
If you are a UK taxpayer 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.