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Your Name

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Personal Details

* Email

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* Home Address

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Gift Aid

All payments are eligible for Gift Aid.

Headland Baptist Church can reclaim the tax paid on this donation. Please remember that you must pay an amount of income tax and/or capital gains tax equal to the tax that is reclaimed for this donation.

I would like Headland Baptist Church to reclaim tax on all donations associated with this Payment Group Registration.

I do NOT want Headland Baptist Church to reclaim tax on this donation.

Payment Details

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* Cardholder Name (As printed on the card)
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* Card Number
* Expiry Date	/
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Start Date (optional: please add if printed on your card)	/
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Cardholder Address

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