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 (delete as appropriate)

starting on the  /   /    until further notice.
My account number is: 

My Sort Code is: 
Name: 
Address: 
  Postcode: 
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.
Thank you
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