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_direct-debit-instructionxxx

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									                                                                                  Instruction to your
                                                                                  Bank or Building Society
                                                                                  to pay by Direct Debit
 Please fill in the whole form including official use box using a ball
 point pen and send it to:                                                        Originator's Identification Number


 Poppyscotland
                                                                                     6 7                1 6                 0         0
 New Haig House
 Logie Green Road                                                                              FOR THE EARL HAIG FUND SCOTLAND OFFICIAL USE
 Edinburgh                                                                                  This is not part of the instruction to your Bank or Building Society.
                                                                                    Name ______________________________________
 EH7 4HR
                                                                                    Address ____________________________________
                                                                                    ___________________________________________
 Scottish Charity No SC014096 Poppyscotland is a company
 limited by guarantee. Registered in Scotland No 194893
Name(s) of Account Holder(s)                                                        Town __________________ Postcode ____________

                                                                                    Phone _____________________________________

                                                                                    Email ______________________________________
                                                                                    I would like to set up a Direct Debit of:

Bank/Building Society account number
                                                                                       £                           Monthly/Quarterly/Annually

                                                                                    Please debit my Bank/Building Society account on :
                                                                                         1st                    15th
Branch Sort Code                                                                  Instruction to your Bank or Building Society
                                                                                  Please pay Earl Haig Fund Scotland 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
Name and full postal address of your Bank or Building Society                     with Earl Haig Fund Scotland and, if so, details will be passed
To: The Manager                                         Bank/Building Society     electronically to my Bank/Building Society.


Address                                                                            Signature(s)




                                           Postcode                                Date



Reference




                              Banks and Building Societies may not accept Direct Debit Instructions for some types of account




                                                This guarantee should be detached and retained by the Payer.




                                               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 Earl Haig Fund Scotland will notify you 10 working days in advance of your account
          being debited or as otherwise agreed.
         If an error is made by Earl Haig Fund Scotland 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. Please also send a copy of your letter to us.
                   Make your donation worth more with Gift Aid and Poppyscotland will
                   continue to receive an extra 28p from HM Revenue & Customs for every £1
                   you donate until 5 April 2011 and 25p thereafter.
I confirm that I pay income tax in the UK. I wish Poppyscotland to reclaim tax on this
donation and all donations in the future until I notify you otherwise.   (please tick box)


Data Protection – Poppyscotland would like to keep in touch with you regarding all aspects of
our important work. If you would prefer not to hear from us at all in the future other than
regarding your regular donation, please tick here.

								
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