Your donation of less than £5 per month you can make a huge difference

By giving regularly you can help us plan more effectively for the future and continue to support people with ME/CFS.

Please return this form to: ME North East

To: The Manager………………………………………..Bank plc (insert your bank name here)

Address: …………………………………………………………(insert your bank address here)

…………………………………………………………… Post Code:……………………..

Please pay ME North East
Lloyds TSB Acc No: 0655784. Sort Code: 30-91-94

The sum of £4.87 per month or £…………...per month

Starting on ………/…………./2007………

Please complete your bank details

Account No:………………………… Sort Code……………………….

Title:…… Name: ……………….. Surname: ……………………………………..

Address………………………………………………………………………………

…………………………………….Postcode: ………………………………………

Tel No: ………………………………….. E-mail: ………………………………….

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

(All details are treated with the strictest confidence and are fully secure)

GIFT AID DECLARATION
If you are a current tax payer we can reclaim tax on your donations. This increases the value of the gift to us - without costing you an extra penny!

Please sign here if ME North East can reclaim tax on your donations.
“I declare that all donations that I have made after 6th April 2000 should be eligible for the Gift Aid Scheme. I understand that I must pay income tax or capital gains and that this must be at least equal to the amount of tax ME North East will reclaim during the year.

Signed ………………………………………. Date……………………………..

ME North East, Bullion Hall
South Approach, Chester le Street.
DH2 2ES. Tel 0191 3892222
e-mail [email protected]