Membership Form2016

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Localgiving Membership form About your organisation

6th floor, 233 High Holborn London, WC1V 7DN

Organisation Name

Telephone: 0300 111 2340 Email: [email protected]

Address

Town / City

County

Postcode

Localgiving Annual Membership Please fill out the Direct Debit Instruction on the last page of this form for your annual membership payment (£96 inclusive of VAT).

Description

Amount

12 months Localgiving Membership

£80

- Own webpage - Online fundraising For more details see: join.localgiving.org

VAT @ 20%

£16

Total to pay

£96

Thank you for completing your membership form. Before you send it back to us please make sure you have included your signed Direct Debit Instruction form. Please return your form to us via:

Email

(Scanned copy)

[email protected]

Post

(Hard copy)

Membership team Localgiving, 6th Floor 233 High Holborn, London, WC1V 7DN

If you have any questions about filling in this form please call our Memberships team on 0300 111 2340

Instruction to your bank or building society to pay by Direct Debit Please fill in whole form with a ball point pen and send to:

Service user number

2 9 7 5 5 5

Localgiving 6th Floor 233 High Holborn London WC1V 7DN

FOR LOCALGIVING OFFICIAL USE ONLY This is not part of the instruction to your bank or building society

Name(s) of account holder(s):

Localgiving Annual Membership £96 (incl. VAT) Please ensure this form is signed by the signatory(s) of the bank account.

Bank/building society account number

Instruction to your Bank or Building Society Please pay Localgiving Ltd 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 with Localgiving Ltd and, if so, details will be passed electronically to my bank/building society.

Branch sort code

Name and full postal address of your bank or building society: To: The Manager

Bank/building society

Address

Signature(s)

Postcode

Date

Reference (for Localgiving’s use)

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 accept instructions to pay Direct Debits • If there are any changes to the amount, date or frequency of your Direct Debit Localgiving Ltd will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request Localgiving Ltd to collect a payment, confirmation of the amount and date will be given to you at the time of the request. • If an error is made in the payment of your Direct Debit, by Localgiving Ltd or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society – If you receive a refund you are not entitled to, you must pay it back when Localgiving Ltd asks you to • You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.