Standing Order Form

Setting up a regular donation helps us plan ahead.

Please complete this form and we will send you a completed Standing Order form for you to sign and return to us for forwarding to your bank.

In the interests of security, you may wish to leave completion of your bank account details until you receive the Standing Order form from us.

Title

First name

Last name

Address line 1

Address line 2

Town

Post Code

Full Tel No

Email Address

Re-enter Email address *

* Please check that both are the same.

I would like to make a regular payment to Contact the Elderly of

Every month

Every quarter

Annually

Starting on (insert day number)

Starting on (insert Month)

My bank and my branch address are:

Call our freephone

0800 716543

Email us here