Meeting House Appeal

First name(s)
Family Name
Address


Town / City
County / State
Post / Zip Code
Country
Telephone Number
E-mail address
Ayton Old Scholar?	Yes / No
At Ayton - from / to	19..........to 19.........

I enclose a donation of	Ł....................................... to the Appeal.
Cheque payable to:	Great Ayton Meeting House Development Fund; or direct to Account No. 61203053 Sort Code 40-35-03 at Midland Bank, 189 High Street, Northallerton DL7 8LQ, UK
If this amount is Ł250 or above and you are a UK taxpayer, the Appeal can reclaim the tax you have paid. We will need to send you a form for signature to enable us to reclaim the tax, so if you arc eligible and will allow us to do this please tick here............... (or delete this section)
We also welcome deeds of covenant for a minimum of four years on which tax can be reclaimed by us if the donor is a UK taxpayer Should you wish to proceed in this way, please complete the section below and we will arrange to send you a Bankers Order and the Covenant forms for your signature.
our Bank
Bank Address

Your Account Name:
Account Number:......................... Sort Code:............................. Amount: Ł.............................
Annually / Quarterly / Monthly (please delete as applicable)
For Number of Years	.....................

Please printout this page and post to:
Martyn Gaudie, Appeal Treasurer,
Stamfrey Granary, West Rounton, Northallerton,
North Yorkshire DL62LJ, United Kingdom.