Standing order pledge form - Epilepsy Scotland

Title

Your Name (required)

Address Line 1 (required)

Address Line 2

City (required)

Region/County (required)

Postcode (required)

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Your Email (required)

Your donation pledge

Please pay Epilepsy Scotland the sum of £

Monthly/Annually (required) [select period* "Monthly" "Annually"]

until further notice, starting on (required)

Gift Aid declaration

I confirm that I am a UK Income or Capital Gains taxpayer. I have read this statement and want Epilepsy Scotland to reclaim tax on my previous and future donations from HMRevenue and Customs. I understand that I must pay an amount of Income Tax and/or Capital Gains Tax in the tax year at least equal to the amount of tax that all the charities and Community Amateur Sports Clubs that I donate to, will reclaim on my gifts for that tax year. I understand the other taxes such as VAT & Council Tax do not qualify. I understand that the charity will reclaim 25p of tax on every £1 that I have given.

By clicking the 'Submit' button, I am attaching my electronic signature to and agreeing to the Terms of Service Agreement; I understand that if I do not agree to these terms of use, I should refrain from using www.epilepsyscotland.org.uk.

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