Can you help us to help others?

Please complete this form, print it and send it with your cheque to: Samaritans, 11 College Place, London Road, Southampton SO15 2FE

 

Donation by cheque
Please find enclosed a cheque for   �     made payable to Southampton & District Samaritan branch

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GIFT AID

If you pay tax you can increase the value of your donation at no cost to you. For every pound you donate, we can claim an extra 28p from the Inland Revenue. If you wish your donation and all future donations to be gift aided until you notify us otherwise, please tick this box and fully complete all your details below.

Name:
Address:
Postcode
Telephone number:
E-mail:

 

Southampton & District Samaritans is a Registered Charity.
Registered Charity No: 249298