Sadler's Wells Patron Joining Form When signed and complete ...
Sadler’s Wells Patron Joining Form When signed and complete, please return to: Development Office, Sadler’s Wells, Rosebery Avenue, London EC1R 4TN I would like to purchase the following Sadler’s Wells Patron membership (please tick one option): Opening Night Patron £600 Commissioning Patron £1000 New Production Patron
£2500
Season Patron
£5000
Name.……………………………………………………………………………………………………. Address.………………………………………………………………………………………………… ………………………………………………………………Postcode………………………..………. Telephone…………………………………… Email ………………………………………………… Patrons are acknowledged in Sadler’s Wells programmes. Please enter below how you wish the person receiving this gift to be acknowledged or whether they would prefer to remain anonymous …………………………………………………………………………………………………………… Please note that by buying a membership you are giving permission for Sadler’s Wells to contact you by phone, email and post with information about your membership and benefits. If you do not want to want to receive any information from Sadler’s Wells, apart from information about your membership and benefits, please tick the relevant contact methods you do not wish to be reached on below. Email
Post
Phone
Other
Payment Details I would like to pay by cheque
(Cheques to be made payable to Sadler’s Wells Trust Ltd)
I would like to pay by direct debit
(Please complete direct debit mandate form overleaf – if you pay by Direct Debit you can receive a 5.5% discount of the price of your membership)
I would like to pay by credit card
Visa MasterCard Switch American Express Card number: Expiry Date Security Code Issue No. (Switch Only) Name of card holder as it appears on the card: …………………………………………………………. Card Holder’s Signature……………………………………………………………………………………..
Patron Direct Debit Form I would like to pay by direct debit (please tick one option): £567.00 DD discount
£600 full price
Commissioning Patron £945.00 DD discount
£1,000 full price
New Production Patron £2,362.50 DD discount Season Patron £4,752.00 DD discount
£2,500 full price £5,000 full price
Opening Night Patron
Name.……………………………………………………………………………………………………. Address.…………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ………………………………………………………………Postcode………………………..……….. Telephone…………………………………… Email …………………………………………………..
Direct Debit is a simple form of automatic annual renewal and helps us to reduce administration. I would like to pay (tick as appropriate): Monthly (12 payments)
Quarterly (4 payments)
Annually (1 payment)
Instruction to your Bank or Building Society to pay Direct Debit (please complete in full) To the manager of ………………………………………………………………………..……… Bank/Building Society………………………………………………………………..…………… Address ……………………………………………………………………………………..…….. Postcode ………………………………………………………………………..………………….
Originators Identification No 6 5 2 7 9 8 Reference No. (Office use only) Instruction to your Bank or Building Society to pay by Direct Debit – Please pay Sadler’s Wells Trust Ltd. Direct Debits from the account detailed in the instruction subject to safeguards assured by the Direct Debit Guarantee. I understand that this instr uction may remain w ith Sadler’s Wells Trust Ltd and, if so, details w ill be passed electronically to my Bank/Building Society
Name(s) of Account Holder(s) …………………………………………………………………… Sort Code ………………………………………………………………..…………………………. Bank/Building Society/Account No ………………………………………………………………. Signature ………………………………………………………………..………………………….. Date ………………………………………………………………..………………………………… Banks and Building Societies may not accept Direct Debit instruc tions for some types of account
HMRC will give Sadler’s Wells 25p for every £1 you donate! In order to Gift Aid your donation you must tick the box below:
I want to Gift Aid my donation and any donations I make in the future or have made in the past 4 years to Sadler’s Wells. 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 Full Name…………………………………………………………………………………… Address……………………………………………………………………………………… ……………………………………………………… Postcode……………………………. Date…………………… Signature…………………………………………………………
If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code.
Please notify Sadler’s Wells 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
£2500
Season Patron
£5000
Name.……………………………………………………………………………………………………. Address.………………………………………………………………………………………………… ………………………………………………………………Postcode………………………..………. Telephone…………………………………… Email ………………………………………………… Patrons are acknowledged in Sadler’s Wells programmes. Please enter below how you wish the person receiving this gift to be acknowledged or whether they would prefer to remain anonymous …………………………………………………………………………………………………………… Please note that by buying a membership you are giving permission for Sadler’s Wells to contact you by phone, email and post with information about your membership and benefits. If you do not want to want to receive any information from Sadler’s Wells, apart from information about your membership and benefits, please tick the relevant contact methods you do not wish to be reached on below. Email
Post
Phone
Other
Payment Details I would like to pay by cheque
(Cheques to be made payable to Sadler’s Wells Trust Ltd)
I would like to pay by direct debit
(Please complete direct debit mandate form overleaf – if you pay by Direct Debit you can receive a 5.5% discount of the price of your membership)
I would like to pay by credit card
Visa MasterCard Switch American Express Card number: Expiry Date Security Code Issue No. (Switch Only) Name of card holder as it appears on the card: …………………………………………………………. Card Holder’s Signature……………………………………………………………………………………..
Patron Direct Debit Form I would like to pay by direct debit (please tick one option): £567.00 DD discount
£600 full price
Commissioning Patron £945.00 DD discount
£1,000 full price
New Production Patron £2,362.50 DD discount Season Patron £4,752.00 DD discount
£2,500 full price £5,000 full price
Opening Night Patron
Name.……………………………………………………………………………………………………. Address.…………………………………………………………………………………………………. ……………………………………………………………………………………………………………. ………………………………………………………………Postcode………………………..……….. Telephone…………………………………… Email …………………………………………………..
Direct Debit is a simple form of automatic annual renewal and helps us to reduce administration. I would like to pay (tick as appropriate): Monthly (12 payments)
Quarterly (4 payments)
Annually (1 payment)
Instruction to your Bank or Building Society to pay Direct Debit (please complete in full) To the manager of ………………………………………………………………………..……… Bank/Building Society………………………………………………………………..…………… Address ……………………………………………………………………………………..…….. Postcode ………………………………………………………………………..………………….
Originators Identification No 6 5 2 7 9 8 Reference No. (Office use only) Instruction to your Bank or Building Society to pay by Direct Debit – Please pay Sadler’s Wells Trust Ltd. Direct Debits from the account detailed in the instruction subject to safeguards assured by the Direct Debit Guarantee. I understand that this instr uction may remain w ith Sadler’s Wells Trust Ltd and, if so, details w ill be passed electronically to my Bank/Building Society
Name(s) of Account Holder(s) …………………………………………………………………… Sort Code ………………………………………………………………..…………………………. Bank/Building Society/Account No ………………………………………………………………. Signature ………………………………………………………………..………………………….. Date ………………………………………………………………..………………………………… Banks and Building Societies may not accept Direct Debit instruc tions for some types of account
HMRC will give Sadler’s Wells 25p for every £1 you donate! In order to Gift Aid your donation you must tick the box below:
I want to Gift Aid my donation and any donations I make in the future or have made in the past 4 years to Sadler’s Wells. 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 Full Name…………………………………………………………………………………… Address……………………………………………………………………………………… ……………………………………………………… Postcode……………………………. Date…………………… Signature…………………………………………………………
If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code.
Please notify Sadler’s Wells 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
