DONATION TO:

Friends of the Church of the Blessed Virgin Mary & St. Leodegarius

I enclose a CHEQUE

amount £

amount in words

title

name

address

post code

I am a UK taxpayer and I would like tax to be reclaimed on the enclosed donation through the Gift Aid Scheme. I note that I must have paid an amount of tax that at least equals the tax deducted from this donation (currently 28p for every £1 given)

signed

date

COMPLETE & PRINT out this form, sign and date it
then send together with your cheque to:
Miss D E Godden
194 Milton Street North
Northampton NN2 7DD

Thank you for your support

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