Sponsor form

PIPE SPONSORSHIP FOR THE NEW ORGAN Chelsea Old Church I / We wish to become a Pipe Sponsor I wish to make a donation towards the cost of the new NAME ................................................................. William Drake organ at Chelsea Old Church by ADDRESS .......................................................... sponsoring the following organ pipe (s) .............................................................................. I wish to sponsor my pipe in the name of : POST CODE .................................................... ......................................................................................... Email .................................................................. ......................................................................................... Gilded display pipe £5,000 16’ £2,500 8’ £1,000 4’ £ 500 2’ £100 Mixture (smallest pipe) £30 To make a donation: Please complete the form and send with a cheque or CAF voucher made payable to ‘The Chelsea Old Church PCC Organ Fund Account’ for £.................., to the Chairman of Fundraising, Mrs Lavinia Wallop, 132 Lexham Gardens, W8 6JE. For donations in excess of £5,000 or to make a payment by BACS please kindly contact Lavinia Wallop by post at the above address or by email: laviniawallop@yahoo.com GIFT AID DECLARATION *please tick box and sign and date below Signature …………………………………………………………. Date / / *I want the Chelsea Old Church to treat all gifts of money that I have made in the past 4 years and all future gifts of money that I make from the date of this declaration as Gift Aid donations. You must pay an amount of UK Income Tax and/or Capital Gains Tax for each year (6th April one year to 5th April the next) that is at least equal to the tax that the Chelsea Old Church Organ Fund and any other charities or CASCs you support will reclaim on your donations for that tax year. (Council tax and VAT do not count). The Chelsea Old Church Organ Fund will claim 25p in tax back for every £1 gift aided. Registered Charity number 1135101