(For office use only)
Appeal code: INWW080000

Thank you for considering a regular gift to Action for Blind People. Please complete the details below and return to Action for Blind People, FREEPOST SE2841, LONDON, SE16 3BR. 

Your name:


Your address:





Your postcode: 

Your email if it ok to email you: 


I want to support Action for Blind People by making donations by Direct Debit of £    every:	month  quarter year (please circle as appropriate)

I would prefer my donations to be made on or around the 
1st or 15th of the month, (please circle as appropriate) starting in:  ______ (month)_______(year)


Name and full postal address of your Bank or Building Society:


Name(s) of account holder(s):


Bank or Building Society Account No: 		Branch Sort Code:


Signature:					Date:

Please pay Action for Blind People Direct Debits from the account detailed in this instruction, subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with Action for Blind People and, if so, details will be passed electronically to my Bank/Building Society.Originators Identification Number: 972979
Banks and Building Societies may not accept Direct Debit instructions for some types of account.

Please return this form once completed to us at Action for Blind People, FREEPOST SE2841, LONDON, SE16 3BR. 

Thank you very much for your support, we really do appreciate it.

Please detach and retain this guarantee

The Direct Debit Guarantee						 
This Guarantee is offered by all banks and building societies that take part in the Direct Debit Scheme. The efficiency and security of the Scheme is monitored and protected by your own bank or building society If the amount to be paid or the payment dates change the organisation will notify you 10 working days in advance of your account being debited or as otherwise agreed If an error is made by the organisation or your bank or building society, you are guaranteed a full and immediate refund from your branch of the amount paid You can cancel a Direct Debit at any time by writing to your bank or building society. Please also send a copy of your letter to Action for Blind People.