THREE COUNTIES DOG RESCUE	                 Registered Charity No. 1170606								

SPONSOR A DOG - application form

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

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

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

Email address  ………………………………………………………………………........................
I supply the above information to enable Three Counties Dog Rescue to manage my Dog sponsorship.
By ticking the box I consent to Three Counties Dog Rescue also holding my details to keep me up to date with their activities.	
						
I/we would like to support Three Counties Dog Rescue through their “Sponsor a Dog” scheme and to make a personal contribution to the scheme of .

£…………… per month by standing order to sponsor  ……………………………
(Arrangements to set up standing order will need to be made at your own bank)

£…………… ‘one-off’ yearly donation to sponsor   ……………………………….    for a year

If the dog you sponsor is re-homed we will offer you an alternative dog to continue the sponsorship

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

Payments should be made to our account at Co-operative Bank.

Sort Code		08-92-99

Account Number	65860298

Please fill in the Gift Aid form on the back, 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. 
If this is to be a gift please attach a slip of paper detailing the recipient’s name and address.

Thank you for your support

Gyll Mauchline 
Three Counties Dog Rescue 
High Park Cottage , Kirkby Underwood Road, 
Aslackby, Sleaford  NG34 0HP
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 name & address so you can be identified as a current UK tax payer. It will only be used for that purpose.
In order to gift aid your donation you must tick the box :	

I want to Gift Aid my monetary donation, the proceeds from the sale of any goods I have donated 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.

Title………… Full Name……………………………….....................................................................................

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

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

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

Post Code……………………………………

Email address………………………………………………………………………………………………..

Please notify Three Counties Dog Rescue through the email address below 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
·	wish to be removed from the mailing list

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

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

·	To satisfy the Gift Aid requirements, Three Counties Dog Rescue will sell any items you have donated acting as an agent on your behalf. Technically, the goods will remain your property until they are sold.
·	Any unsold goods will be disposed of by Three Counties Dog Rescue at their discretion.
·	We will contact you to advise you how much the sale of your items has raised if that exceeds £100 in total over a tax year. Unless we hear from you within 21 days, we will assume that you are happy for us to retain the excess.