Becoming a Friend of Adderbury Library

FRIENDS FORM

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I wish to become a FRIEND of Adderbury Library at a cost of:-

£20.00 per annum for individual / £25.00 per annum for family

(or whatever you can afford, all amounts are confidential)

 

NAME
ADDRESS  

 

TELEPHONE
EMAIL

By completing this form, you give permission for Focal to hold your personal information. We will only use this information to inform you of news about the Library and Friends events, appeals and renewals of memberships. You may withdraw this consent in writing at any time.  We take your privacy seriously and store your data securely.  Your data will not be shared with any other organisation.

Payment Options

– I enclose a cheque for £ …………… made payable to Focal

– I am enclosing the amount of £ ……………… in cash

– I wish to set up a standing order for £ ………….. per annum

Please treat as Gift Aid donation (from taxed income)

Tick the box if you wish to do this

 

Signature ………………………………………………………………………..     Date …………………………………………..

Thank you for helping to keep Adderbury Library open

 

Standing Order Mandate

To: The Manager, Bank/Building Society:
Address  

 

Sort Code: –                – Account No:
Payment Instructions:
Pay the sum of: £ Pounds (in words)
On: (date) Each year /   quarter / month
Bank: Lloyds plc, 12 High St Banbury Oxon   Sort Code: 30-90-42     Account No: 07291653

Account Name: Focal

Signature ………………………………………………………………………..     Date …………………………………………..