Firefly - Printable Standing Order Form

Firefly Standing Order Form

I wish to commence a standing order of £ per month, starting on:

Title:

* First Name:

* Surname:

* Address line 1:

* Address line 2:

* PostCode:

Email address:

Telephone No:

* Your Bank/Building Society Name:

* Bank address line 1:

* Bank address line 2:

* Bank Post Code:

* Branch Sort Code:

* Account No:

* These fields are mandatory

Instructions to your Bank/Building Society: Please pay the above amount to the account of Firefly, Account No: 80900729 Sort Code: 20-29-23

Signed: ___________________________________ Date: _____________________

Please check this information, print the form and return this form to:
Firefly International, c/o Ellie Maxwell, Flat 10, 31 Morrish Road, London SW2 4EB. Thank You.
OR
I enclose a one-off gift of £______________ (Please make cheques payable to Firefly and send to above address)
Yes - I would like Firefly to reclaim the tax paid on all donations I have made since 6 April 2000 and any future donations I might make.*
I am not a UK taxpayer
* For Firefly to reclaim tax on your gifts, you must have paid UK Income or Capital Gains Tax to the value of tax to be reclaimed.

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Title:
* First Name:
* Surname:
* Address line 1:
* Address line 2:
* PostCode:
Email address:
Telephone No:
* Your Bank/Building Society Name:
* Bank address line 1:
* Bank address line 2:
* Bank Post Code:
* Branch Sort Code:
* Account No:
* These fields are mandatory