Donation Form

Thank you for choosing to make a donation to Crossroads Care Brentwood Basildon & Districts. Please print off and complete this form and return it with your donation to Crossroads Care, 2nd Floor, 51 Tallon Road, Hutton, Brentwood, Essex CM13 1TG.  Remember that we can benefit even more from your donations if you are a tax payer and complete the Gift Aid Declaration section of this form. 


Your Name & Address

 

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..................................................................................     Telephone No. ........................
 
Type of Donation (please tick the appropriate box(es))

[  ]   I/We wish to sponsor ____ Care Hours annually at £20 per hour and enclose a cheque for £_______

[  ]   I/We wish to become a member of Crossroads Care Brentwood Basildon & Districts and enclose a cheque for £____   as my/our subscription for the current year (minimum £10 or £25 for Corporate membership)

[  ]  I/We wish to make a regular donation to Crossroads Care Brentwood Basildon & Districts. Please send me a Bankers Order form. 

Please send me a receipt [  ] more information [  ] a Covenant form [  ]

Signed: ____________________        Date:   ______________

Please make cheques payable to:- Brentwood & District Crossroads Care

 

 Gift Aid Declaration

Charities benefit more from your donations/membership if you are a tax payer and complete the following Gift Aid declaration. This will not affect your tax code or the amount you pay, but will benefit Crossroads.

I, ______________________________would like Crossroads Care Brentwood Basildon & Districts to reclaim tax* on all donations I have made since 6 April 2000 and on any donations I make in the future until further notice.

Signed: ____________________        Date:   ______________
 

* Notes

1. You can cancel this declaration at any time by notifying the charity.
2. You must pay an amount of income tax and/or capital gains tax at least equal to the tax that the charity
reclaims on your donations in the tax year (currently 28p for each £1 you give).
3. If in the future your circumstances change and you no longer pay tax on your income and capital gains equal
to the tax that the charity reclaims, you can cancel your declaration (see note 1).
4. If you pay tax at the higher rate you can claim further tax relief in your Self Assessment tax return.
5. If you are unsure whether your donations qualify for Gift Aid tax relief, ask the charity. Or ask your local tax
office for leaflet IRI 13 Gift Aid.
6. Please notify the charity if you change your name or address.
 

Charity Registration No. 1054595 A company limited by guarantee registered in England No. 3172543