THREE COUNTIES DOG RESCUE                              
 Registered Charity No. 1170606
							
DONATION  - application form

Name……………………………….......................................................................................................

Address………………………………....................................................................................................

………………………………................................................................................................................

………………………………................................................................................................................

Email address ………………………………………………………………...........................................
(to contact you regarding Three Counties business)

I/we would like to support Three Counties Dog Rescue

I/we would like to make a personal contribution of 

£…………… per month by Standing order. (Arrangements will need to be made at your own bank)

Signature………………………………..........................................

Payments should be made to our account at:
The co-operative bank
Three Counties Dog Rescue
 Sort code:08-92-99
Account no. 65860298

Please also fill in the Gift Aid form on reverse, if it is appropriate, so that Three Counties can maximize your donation at no additional cost to you by recovering the income tax on the payment from Inland Revenue.

Thank you for your support

Gyll Mauchline
Three Counties Dog Rescue
High Park Cottage, Kirkby Underwood Road
Aslackby, Sleaford	NG34 0HP
www.threecountiesdogrescue.org		

THREE COUNTIES DOG RESCUE                                       
Reg. Charity No. 1170606

CHARITY GIFT AID DECLARATION 					Date……………….…….

Boost your donation by 25p of Gift Aid for every £1 you donate

Gift Aid is reclaimed by Three Counties Dog Rescue from the tax you pay for the current tax year. We need your address so you can be identified as a current UK tax payer.

In order to gift aid your donation you must tick the box below:

I want to Gift Aid my donation of £………………………and any donations I make in the future or have made in the past 4 years to Three Counties Dog Rescue. 

I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference.

My Details 

Title………… Full name……………………………….........................................................................................

Address ……………………………….................................................................................................................

……………………………….................................................................................................................................

………………………………………………………………………………………………………………………………

Post Code……………………………………

Please notify Three Counties Dog Rescue if you:
•	want to cancel this declaration
•	change your name or home address
•	no longer pay sufficient tax on your income and/or capital gains

Signature:……………………………….....................................

Three Counties Dog Rescue can be contacted by writing to them at:
High Park Cottage, Kirkby Underwood Road, Aslackby, Sleaford  NG34 0HP  by Tel: 01778 440318
or email to info@threecountiesdogrescue.org