Make a regular gift to WSPA by Direct Debit Title First Name Surname Address Postcode Telephone Number This is my Home Work Mobile number Email address Can we contact you via email? Yes No I would like to give: £5 £10 £ other (minimum £3) every month (These are just suggestions and whatever you feel you would like to contribute is always appreciated) starting on 1st 8th 15th 22nd of each month (If no date is specified, payments will be collected on the first day of each month) Your support is vital to the work we do and we thank you for it. We also respect your privacy and would assure you that WSPA fully comply with the Data Protection Act (1998). From time to time we may want to pass your details to other similar organisations that you may also feel able to support. If you do not want us to do this, or do not wish to receive future communications from WSPA please tick the relevant box. I do not wish you to pass any information you hold on me to any other parties. I do not wish to receive any future communications from WSPA or WSPA Trading Instruction to your Bank or Building Society to pay by Direct Debit Please fill in the form and return it to: WSPA, Dept IW5, FREEPOST SCE6686, Melksham SN12 6GZ Name and full postal address of your Bank or Building Society To: The Manager Bank/Building Society Address Postcode Name(s) of account holder(s) Branch sort code Bank/Building Society account number Banks and Building Societies may not accept Direct Debit Instructions for some types of account. Originator’s identification number WSPA reference number (for office use only) 4 0 6 0 6 0 Instruction to your Bank or Building Society Please pay WSPA Direct Debits from the account detailed on this instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with WSPA and, if so, details will be passed electronically to my Bank or Building Society. Signature(s): Date: PLEASE TEAR OFF AND RETAIN 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 protect by your own Bank or Building Society. If the amounts to be paid or the payment dates change WSPA will notify you 10 working days in advance of your account being debited or as otherwise agreed. If an error is made by WSPA 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.
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