Print this page from the print command on your computer.  Then complete the form to make a monthly donation.  
Send the form to our Registered Office: 

Down's Syndrome Research Foundation, 
18 Daws Hill Lane,
High Wycombe, Bucks,
HP11 1PW

Make sure to include your name and address -  so we can stay in contact with you.

Standing Order Mandate

To: (Name of your bank) ___________________________________________________

(Bank) Street Address ___________________________________________________________

City _____________________________________  Post code _____________________

Email address __________________________________  Phone ___________________

Please pay: 
The Down's Syndrome Research Foundation, 
Account: 00082636  Sort Code 40-52-40 
CAF Cash Ltd, Kings Hill, West Malling, Kent ME19 4TA.   

Gift Aid “ I am a UK taxpayer and I would like the DSRF to reclaim tax on all donations made during this
 tax year and on all future donations.  My annual tax payment is more than the tax  refund the DSRF will
reclaim on this donation ”   If you agree the DSRF will receive and additional 28% from the UK Government
under the Gift Aid scheme.

I agree with the above statement please reclaim the tax benefit on my donations to the DSRF_________ Initial

I wish to donate the following amount to the DSRF. 

The sum of  £ ____________   .(Amount in words) _______________________________

Commencing (Date of first payment) ________________________

And every month thereafter until further notice in writing.  

Or until last payment on ________________________________

Account to be debited: (Your account name)   __________________________________

Account number: (Your account number)   _____________________________________

Your Address  ___________________________________________________________

City  __________________________________         Post code ____________________

Your Signature (s) ____________________________________   Date _______________