loser

DONATION FORM
Please complete the following and return to:
Development Department, Freepost SE7022, Southbank Centre, Belvedere Road, London SE1 8BR
Southbank Centre is a registered charity no 298909
TITLE FORENAME SURNAME
ADDRESS
POSTCODE
TEL
EMAIL
LEVEL OF SUPPORT
I WOULD LIKE TO JOIN:
Artists’ Circle - £250 to £1,000 or minimum £20.83 per month
Directors’ Circle - £1,001 to £2,499 or minimum £83.33 per month
OR:
Artistic Director’s Circle - £2,500 or minimum £208.33 per month
I do not wish to join but would like to make a donation
Gift Aid Declaration
Please treat as Gift Aid donations all qualifying gifts of money made: today in the past 4 years in the future
Please tick all boxes you wish to apply.
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 Southbank Centre will reclaim 25p of tax for every £1 that I give.
Signature
Date
Please notify us if you no longer pay tax equal to the tax we reclaim on your donations or if you change your name or address.
PAYMENT OPTIONS
REGULAR PAYMENT: To make a regular payment by Direct Debit please complete the form opposite
ONE–OFF PAYMENT: I enclose a cheque made payable to ‘Southbank Centre’ for £
OR: Please debit my Mastercard/Visa/Delta/Switch/Maestro/Amex for £
(please circle one)
CARD NUMBER ISSUE NUMBER
VALID FROM EXPIRY DATE SECURITY NUMBER
SIGNATURE DATE
(Switch
only)
We would like to keep you up to date with events and activities at Southbank Centre.
Please tick the boxes below if you do not wish to receive information in the following ways:
By mail
By email
By phone
Would you like to hear from other organisations in which we think you will be interested?
Yes
No