Your Direct Debit (Step 1 of 2)

Please complete all the pages of this form to start your Direct Debit. Your details will be sent over a secure connection. If you have issues completing this form please email supportercareteam@maggiescentres.org or call Mon-Fri 9am-5pm 0300 123 1801.

* You must complete the fields marked with an asterisk.

Your Direct Debit
  1. *£
  2. *  
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  4. Gift Aiding your donation today would make your donation worth £7.5
  5. Gift Aid

    By ticking the box above I 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 year it is my responsibility to pay any difference.

Your bank account details
  1. In order to set up a Direct Debit Instruction online, you must be the account holder of a personal bank or building society account. If you are not the account holder, or not the only person required to authorise debits from the account, you must complete a Paper Direct Debit Instruction.
  2. *
  3. *
  4. * -  - 
Personal details
  1. *
  2. *
Your address details
  1. *
  2. *
  3. *
  4. *