Autumn Appeal Donation

Next Steps: Install a Payment Add-On

To accept donations on this form you will need to install one of our payment add-ons. To learn more about your payment add-on options, visit the following page (https://www.gravityforms.com/blog/payment-add-ons). Important: Delete this tip before you publish the form.

Donation Amount (in £):

Your Information

Name:(Required)

Prefix First Last

Address:(Required)

Street Address Address Line 2 City/ Town County Post Code Country

Email:(Required)

Phone:(Required)

Would you like to receive a postal thank you letter for your donation?(Required)

Yes, I would like to receive a thank you letter

No, I would not like to receive a thank you letter

Can we claim Gift Aid on your behalf?(Required)

If you are a tax payer we can claim gift aid on your behalf and make your donation go further at no additional cost to you. For every £1 you donate we are able to claim back 25p, you only have to be a tax payer and tick YES.

YES, I confirm I am a UK taxpayer and would like all my donations to Longfield Hospice made now, in the past four years and in the future to be treated as Gift Aid donations

NO, I am unable to Gift Aid my donation

Please remember to let us know if your tax status, name or address change or if you wish to cancel your Gift Aid declaration.

Contact Preferences

Can We Contact You By EMAIL(Required)

YES

NO

Can We Contact You By POST(Required)

YES

NO

Can We Contact You By PHONE(Required)

YES

NO

Can We Contact You By TEXT SMS(Required)

YES

NO

What is your preferred method of contact(Required)

Keeping in Touch

We’d love to get in touch from time to time to keep you informed about the work of Longfield and provide you with exciting updates on our care, news and ways you can get involved. Please tick the boxes below to indicate your preferences on what you want to hear from us.

What type of things would you like to hear about?(Required)

Select all that apply

News & Events

Fundraising

Volunteering

Do not contact me

How did you hear about our Autumn Appeal?(Required)

If other, please specify:

Your information is held in a secure manner and we do not share your information with third parties, except for essential payment processing. You can at any time update your communication preferences with us by contacting the Fundraising Department. Click here to see our privacy notices and fundraising promise.

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