form

To the Manager	Bank Plc
Sort Code
Housename/House Number
Street Name
Town
County
Postcode
Your Account Name
Your Account No.
PAY THE ROYAL BANK OF SCOTLAND
Southport Branch - 267 Lord Street, Southport, PR8 1PH
Sort Code 16 - 32 - 10
Account No. 13752916

Account Name :-
"RSPCA Southport, Birkdale & District Branch"

Date of first payment
Amount of first payment £
Please quote Reference	(Your Name)
Thereafter pay £
Payment Options	Until Further Notice

Being a taxpayer, I want the RSPCA to reclaim tax on all my donations. Please treat all donations made by me after the date of this Declaration as GIFT AID DONATIONS.
Signed .........................................................	Date .................................

Please send this completed and printed form to:- The Branch Secretary, RSPCA Animal
Shelter, New Cut Lane, Birkdale, Southport, PR8 3DW.