Bloodwise - a blood cancer charity beating blood cancer since 1960

I would like to donate *

I want to contribute this amount every month for installments

Your recurring contribution will be processed automatically. You can specify the number of installments, or you can leave the number of installments blank if you want to make an open-ended commitment. In either case, you can choose to cancel at any time.

Email Address *

Contact details

Title

First name *

Last name *

State

Address line 1

Address line 2

City

Postcode

Country

Direct Debit Information

In order to set up your Direct Debit Instruction on-line you will need to provide the following information through the setting up procedure (your cheque book contains all the bank details that you require):

Bank or Building Society name and account number, sort code and branch address.

If you are not the account holder, a paper Direct Debit Instruction will be sent for completion. Please click to end
If this is a personal account continue with the set-up procedure
If it is a business account and more than one person is required to authorise debits on this account, a paper Direct Debit Instruction will be sent to the Payers for completion.

Alternatively you can print off your on-screen Direct Debit Instruction and post it to us. If you are unable to print please contact us on 020 7504 2200 (tel no) and we will post you a paper Direct Debit Instruction. If you do not wish to proceed any further please click here to end.

The details of your Direct Debit Instruction will be sent to you within 3 working days or no later than 10 working days before the first collection.

Account Holder

Sort Code

Bank Account Number

Bank Name

Please confirm that you are the account holder and only person required to authorise Direct Debits from this account

Preferred Collection Day

Confirm By

Please check this box to enter your billing address, if different from above.

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Additional Information

Have you been affected by a blood cancer? *

Which blood cancer?

Gift Aid

Yes, I am a UK taxpayer.Please treat all donations I have made over the past four years and all future donations (unless I notify you) as Gift Aid donations.

Agreement Your account data will be used to charge your bank account via direct debit. While submitting this form you agree to the charging of your bank account via direct debit.