• I would like to make a project donation of £__________
• I would like to make a regular donation.
  Name of your Bank:__________________

Your account number:_______________

Your sort code: ____________________

Please pay Children’s Hearts __________

Starting on (date)____________until further notice

YOUR SIGNATURE

_________________
For bank Use: Children’s Hearts, The Co-operative Bank, Sort Code: 08-92-99, A/c 650 643 24.

For UK tax payers:

I confirm that I wish to make a gift to Children’s Hearts under the Gift Aid Scheme.

Name:

Address:

Postcode

This form is signed in acknowledgement that I am a UK tax payer, resident in the UK for tax purposes. I also acknowledge that I would like Children’s Hearts to reclaim tax on all donations I make in the future.

Signature:

Date: