BRONZE Friend of Hospice

Please complete the form below to donate £10 per month and become a

Bronze Friend of Hospice

Registered Charity No: 1086837

Your name

Your address *

Your email address*

Your phone number

I want to be a Bronze Friend of Hospice

£10

Would you like to Gift Aid your donation? Every £1 will be worth £1.25 to us at no extra cost to you

Yes I would like you to claim Gift Aid on my donations

I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference.

Please enter any message to go with your donation

Please enter your card details below

Card Number*

Expires*

Security Code*

When you press Donate we will take to you a secure form to enter your bank account details

Yes, I am using my own money and would you to claim Gift Aid on my donations

I am a UK taxpayer and have paid enough tax for Hospice at Home West Cumbria to claim Gift Aid on my donations now, in the future and in the past 4 years. I understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference. I also understand it is my responsibility to inform Hospice at Home West Cumbria if I no longer want them to claim Gift Aid.

Can we send you emails?

Can we send you mail?

Can we phone you?

Can we send you text messages?

How would you prefer us to get in touch with you?

There is a problem with this form - please correct the errors and re-try

This form is protected by Google reCAPTCHA the Privacy Policy and Terms of Service apply