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Donation Details

Amount (£) *

Frequency *

One-off donation
Regular donation

I wish to make a regular payment *

Reason for giving *

Please specify your reason for giving *

Gift Aid *

Boost your donation by 25% at no extra cost to you.

By marking this box, I confirm that I would like all my donations past, present and future to Demelza (Registered Charity Number 1039651) to be treated as Gift Aid donations. I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year, it is my responsibility to pay any difference. Please notify us if your circumstances change.
Please mark here if you are not a UK taxpayer

Personal Details

Title

First Name *

Last Name *

Email *

Telephone

Date of Birth

Your support helps provide extraordinary care to extraordinary children. We look forward to keeping in touch with you by post or phone with updates about our work.

Demelza respects your privacy and will process your details in accordance with UK and EU Data Privacy Regulations and will never sell or share your information. To learn more, please view our Privacy Policy. If you prefer not to receive updates by post or phone, please complete our opt-out form or contact us.

Keep in touch

Yes, I'm happy to hear from you by email
Yes, I'm happy to hear from you by text and online

Payment

Card Number *

Expiry Date *

Security Code *

Declaration: I confirm I wish to set up a Direct Debit. *
Authorisation: In order to set up an online Direct Debit you must be the account holder of a personal bank or building society account and the sole required signatory on the account *

Please specify your preferred collection date. If the collection date selected falls within the next 21 days, the first payment may be collected the following month.

Collection Date *

Account Holder Name *

Sort Code *

Enter your 6-digit sort code without hyphens or spaces

Account Number *

Enter your 8-digit account number without hyphens or spaces

Alternatively you can download and complete our paper Direct Debit form here.

Postal address: Demelza Hospice Care for Children, Rook Lane, Sittingbourne, Kent, ME9 8DZ

Email: fundraising@demelza.org.uk

Donation Details

Personal Details

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Summary