Standing Order Form to the Parish Church of St Andrew, Chippenham
(Registered Charity 1131163)

Please print this form off, complete it and return it to Ros Harford or Wendy Reeves, address below

Title                                                                       Full Name

Post Code                                                              Tel. No.

I would like to pay my contribution by (tick applicable)

a. Standing Order from my bank or building society which I will arrange via the internet 
b. Standing Order from my bank or building society and I have completed the form below. 

Gift Aid Declaration:


If you pay any income tax, even on bank or building society interest, please sign the following declaration in order for the Church to recover the tax paid.

I want the Church to reclaim tax on all my donations and note that I should advise the Church if I do not pay an amount of tax that at least equals the tax deducted from this donation.

Signature                                                                  Date

Don’t send direct to your Bank, Ros/Wendy will collectively post them off to the Banks – If you can email, then please complete the necessary information on line or by post and forward to:
Giving Officer: Ros Harford 101 Studley Hill, Studley, Calne SN11 9NL
or Gift Aid Officer: Wendy Reeves 269 London Road, Chippenham SN15 3AS

Standing Order     fill in your bank details

To the Manager,                                                                        (Bank or Building Soc.)


Please pay to the Parochial Church Council of St. Andrew, Chippenham at

HSBC Bank plc, 2 Market Place, Chippenham, Wiltshire, SN15 3HE;

Sort Code 40-17-17;

Account Number 71172948

the sum of £ (figures) (words)
commencing on the first day of ____________ and a like sum every month / quarter / year until December 2020 and debit my account with each payment when made.
This is a (tick applicable box)  new instruction; /  amended instruction, please cancel previous instruction in favour of the above payee.

Signature                                                                                    Date

Account number

Account name

Sort Code

This Standing Order Form will only be seen by the Giving/Stewardship Organiser and Gift Aid Officer, who will, if appropriate, be in touch to make any necessary arrangements. (Standing Order Form April 2020)