Support
the Gallery !
Brazilian Touch Gallery Standing Order Form and
Gift Aid Declaration
The most convenient method of annual/monthly payment of
donations to the Brazilian Touch Gallery is by standing
order. Please print then complete and sign the form below
and return it to Brazilian Touch Gallery
Office. We will forward it to your bank.
Bank Name
......................................................................................
Bank Address
...................................................................................
....................................................................................................
Please pay Brazilian Touch's Office,
475 San marin Dr, USA,CA 94945
for credit to the Brazilian Touch Gallery private
account no. 4901833495, the sum of
Sum in Figures $
.....................................annually/monthly*
(* please delete as appropriate)
Sum in Words
....................................................................................
Annually on ......./......./.......
OR
on the first day of each month, starting ......../......../........
Title
.....................................................................................
Surname
.....................................................................................
Forenames
.....................................................................................
Full Address
.....................................................................................
....................................................................................................
Account number to be debited................................................................
Sort code
......./......../........
Signed
......................................................................................
Date
......................................................................................
Please treat the above donation (and all future donations*) as Gift Aid donation
(* delete if appropriate)
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