Standing Order

Herriot Hospice Homecare Standing Order Form

Herriot Hospice Homecare needs regular supporters to help us to give the opportunity to patients with life limiting illnesses, who wish to stay at home for as long as possible, the choice to do so by providing dedicated palliative care workers and trained volunteers, who provide support for them and their carers.  We will keep you in touch with the work your valuable support is helping to fund through our quarterly newsletter.

YES, I WOULD LIKE TO SUPPORT HERRIOT HOSPICE HOMECARE BY STANDING ORDER

Banker's Order - Instruction to your bank/building society to pay by banker's order.

Your Name and Address:  ..................................................................................................................

.................................................................................  Postcode:  .......................................................

Bank/Building Society Name:  ............................................................................................................

Bank's Full Postal Address:  ..............................................................................................................

.................................................................................  Postcode:  .......................................................

Name of Account Holder(s):  ............................................................................................................

Account No:  ...........................................................................  Sort Code:  .......... - .......... - ............

Amount You Would Like to Donate:  £.....................................

Frequency (monthly,/quarterly/annually):  ...............................

Please pay Herriot Hospice Homecare (CAF Bank Ltd, 25 Kings Hill Avenue, WEST MALLING, ME19 4JQ, UK, Sort Code No: 40-52-40, Account No: 0007119) the amount shown above at the frequency also shown above from the date of signature until further notice.  I/We understand that I/We can cancel this standing order at any time.

Signature:  ..............................................................................  Date:  ...............................................

As I pay income tax I would like this, and all other donations I may make from this date, to be treated as 'Gift Aid' in order for Herriot Hospice Homecare to claim the tax relief on my donation until I notify you otherwise.

Signature:  ..............................................................................  Date:  ...............................................

Please return this form to:

Herriot Hospice Homecare, Zetland House, Friarage Hospital, NORTHALLERTON, DL6 1JG

Please note that we will not pass your details on to any third party without your written consent