To make a donation to Action for Blind People,
please print out this form, complete it and post to:
Action for Blind People, Freepost, London SE16 1BP

Yes, I want to make a real difference to the lives of blind and partially sighted people!
Please accept my gift of:

• £15   • £25  • £50  • £100  • £500  • £1,000  • Other £____

Title 	   
First Name 	   
Last Name 

Address 



Town / City 

Post Code 
e-mail address
Telephone

• I enclose a cheque made payable to: Action for Blind People

• I would like to give through my Visa/ MasterCard/ Switch/ Delta/ CAF CharityCard (please circle)

Card number:																							

Issue No.(Switch only)					Expiry date												

Signature __________________________   Today’s date _________________________

• Please tick here if you wish to receive an acknowledgement - 
• Gift Aid Declaration (please tick if you can – it really makes a difference!)

I want Action for Blind People to reclaim the tax paid on my donations.  Please treat all my donations from 6 April 2000 and until further notice as Gift Aid.  I am a UK taxpayer where the amount of tax and/or capital gains tax is at least equal to the tax to be reclaimed by Action for Blind People (currently 28p for every £1 that I give).

Signature______________________  Today’s Date______________________________

N.B.  Any information supplied by you is subject to the provisions of the U.K. Data Protection Act.  We can, on occasion, raise more funds for blind and partially sighted people by approaching supporters of other voluntary organisations and allowing them to contact our supporters in return.  If you prefer not to be contacted in this way, please tick here. 


Reference:  INWW080000