Can you help us to help others on a regular basis?

Please complete this Standing Order Form, print it, sign it and send it to: Samaritans, 11 College Place, London Road, Southampton SO15 2FE

To the Manager
Bank name:
Bank address:
Postcode:

Please pay:   £     per   month   quarter   year      (please tick)

To “Samaritans – Deed Deposit Account”, Lloyds TSB.   Sort code: 30-97-80   Account number: 07231404

---

To be paid from
Name of account:
Account number
Sort code:
Signature(s)	____________________________________
Date:

---

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