Please let us know what prompted you to donate today*
 
 
If you selected 'Other', please give us more detail below
 
 
 
 
 
Direct Debit Instruction and Payment 
 
 
 
Please pay TLG the monthly sum of*
 
 
On the*
 
 
Please pay TLG 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 TLG and, if so, details will be passed electronically to my bank/building society. 
 
 
 
Sort code*
 
 
Account number*
 
 
 
Account holder name(s)*
 
 
 

Please note: The Direct Debit Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits. If there are any changes to the amount, date or frequency of your Direct Debit, TLG will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request TLG to collect a payment, confirmation of the amount and date will be given to you at the time of the request. If an error is made in the payment of your Direct Debit, by TLG or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society. If you receive a refund you are not entitled to, you must pay it back when TLG asks you to. You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.

 
Gift Aid Declaration 
 
 
 
If you are a UK taxpayer your donation could be worth 25% more at no extra cost to you! 
 
 
 
Can we claim Gift Aid?*
 
Yes
No
 
 
 
 
By ticking 'Yes', you are confirming that you are a UK taxpayer and would like TLG to claim Gift Aid on this donation, any future donations and on any donations you have made in the last four years. You understand that you must pay enough income tax and/or capital gains tax each tax year to cover the amount of Gift Aid that all charities and community amateur sports clubs claim on my donations in that tax year, and you are responsible for paying any difference. 
 
 
 
Please remember to let us know if your tax status, name, or address change or if you wish to cancel your Gift Aid declaration. 
 
 
 
Your Details 
 
 
 
Please note: the following information is required for us to process your gift as quickly and efficiently as possible. 
 
 
 
Title*
 
 
First Name*
 
 
Last Name*
 
 
Address Line 1*
 
 
Address Line 2
 
 
Town/City*
 
 
County
 
 
Postcode*
 
 
Email*
 
 
Phone Number*
 
 
 
 
 
Data Protection & Communication 
 
 
 
TLG takes your privacy very seriously and stores your information in a secure database. TLG is a registered charity in England and Wales no. 1074114 & Scotland no. SC050810, and a registered data user, no. Z9118214. To view our privacy policies, click the link below.
Privacy Policies 
 
 
 
 
 
I have read and understood the above data protection statement.*
 
 
 
 
 
Let us know how we can contact you:
  
Email*
 
Yes
No
 
Phone*
 
Yes
No
 
 
Post*
 
Yes
No
 
Text*
 
Yes
No
 
 
 
 
 
You can change how we contact you at anytime by calling our Supporter Care Team on 01274 900377 or emailing supportercare@tlg.org.uk. 
 
 
 
Is there anything else you'd like to tell us?