Donation Form

If you wish to make a regular monthly donation by standing order or credit card please complete the form below.

If you would prefer to make a donation by cheque or postal order please make payable to Penumbra.

You can print this donation form and mail it to us at:

Penumbra, Norton Park, 57 Albion Road, Edinburgh, EH7 5QY.

 

 

 
Name
Address
Town
Postcode
Telephone
E mail Address
I Enclose A Donation Of: (please tick)
£100 £ 50 £ 25
£ 15 £ 10 Other £
Remember your donation can be increased at no cost to yourself
by making it through the Gift Aid Scheme, if you are a taxpayer.
Just sign part 4 below when you have completed either parts 1, 2 or 3
and we'll do the rest.

Payment methods:

1. By cheque or postal order - made payable to Penumbra

2. By Standing Order

To: The Manager: Bank/Building Society Name:_____________________
Bank/Building Society Address:__________________________________
______________________________________Postcode:_______________
Branch Sort Code Account Number Name(s) of Account Holder(s)
Amount per month:______________________ Commencing (date):_______________________
Signature______________________ Date________________________

3. By Credit / Debit card

Name on card
Card Issuer
(eg Visa, Access)
Card Number
Valid From
Expiry Date

 

4. Gift Aid I want Penumbra to treat all donations I make from the date of this declaration until I notify you otherwise to be treated as Gift Aid Donations.
Signature______________________ Date________________________
I would like to recieve email or postal communication from Penumbra.