Regular Giving by Direct Debit - complete the form online

Rapid Response Fund

Help provide emergency aid in response to natural disasters

I would like to make a regular gift to USPG Please note that in order to set up a Direct Debit instruction on-line, you must be the account holder of a personal bank or building society account. If you are not the only required signatory on your account or you would rather send us a paper version please download a form here and return to USPG, 200 Great Dover Street, London, SE1 4YB. If you have any queries about this form, please contact USPG on 020 7378 5678 or email enquiries@uspg.org.uk

Title:
Forenames:
Surname:
Address:
Postcode:
Email:
Tel:
Amount: £	to be debited monthly \| quarterly \| annually until further notice
This replaces my existing Standing Order to USPG:
I would like my donation to be used towards...

I would like my Direct Debit to start on: Direct Debits are collected on 1st or 15th of the month 1st \| 15th (Please note that the first payment may not be taken from your account until the following month depending on how close it is to your chosen date)

	If you are a UK taxpayer, simply tick this box to make your donation worth more: Date: 31st July, 2010 I want all donations that I have made to USPG for the six years prior to this year (but no earlier than 6th April 2000) and all donations that I make from the date of this declaration until I notify you otherwise, to be treated as Gift Aid donations. (To qualify for Gift Aid, what you pay in Income and/or Capital Gains Tax must equal the amount we will claim in a tax year.)

200 Great Dover Street, London, SE1 4YB. 020 7378 5678

Direct Debit Instruction - please complete in full

Name and full postal address of your Bank or Building Society
The Manager [REPLACE WITH NAME] Bank/Building Society Address: Postcode:

Names(s) of Account Holder(s)

Bank / Building Society account number

Branch sort code
--

Instruction to your Bank or Building Society to pay by Direct Debit

Service User Number
4 2 8 7 7 8

Instruction to your Bank/Building Society
Please pay USPG: Anglicans in World Mission, Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with USPG: Anglicans in World Mission and, if so, details will be passed electronically to my Bank/Building Society.

Date: 31st July, 2010

(Banks and Building Societies may not accept Direct Debit instructions for some types of account.)

Direct Debit

The Direct Debit Guarantee

This Guarantee is offered by all Banks and Building Societies that take part in the Direct Debit Scheme.
The efficiency and security of the Scheme is monitored and protected by your own Bank or Building Society.
If the amounts to be paid or the payment dates change USPG: Anglicans in World Mission will notify you 10 working days in advance of your account being debited or as otherwise agreed.
If an error is made by USPG: Anglicans in World Mission or your Bank or Building Society, you are guaranteed a full and immediate refund from your branch of the amount paid.
You can cancel a Direct Debit at any time by writing to your Bank or Building Society.

Confirmation of your direct debit instruction will be sent to you via post within three working days or no later than 10 working days before the first collection.

By clicking on the proceed button below you are confirming that you are the account holder and that you are the only person required to authorise debits from this account.

Contact

enquiries@uspg.org.uk
www.uspg.org.uk

Registered charity number 234518

USPG Ireland details