Request for Statement of Giving

If you would like to receive a statement for your charitable giving for the period 6th April 2010 – 5th April 2011, kindly fill your details below. Please note that this statement will only include all your traceable donations supported by your adequately filled offering envelopes. Alternatively, you may download the form attached below, fill and send it via email to finance@jesushouse.org.uk. Please note that statements will only be sent out after 24th April, 2011. Thank you.

Title: * - Select -MrMrsMissMsDrProfSir

First Name: *

Middle Name:

Last Name: *

Your Name:

As you would like it to appear on your statement of giving

Previous Name(s):

Any previous names you've been known by in the past year

Company Name:

(If you also give by company cheques) Please note that a separate statement will be provided for the company

Address

Please provide your postal address, ensure that it is typed correctly.

Address Line 1: *

Address Line 2:

City: *

Postcode: *

Problems with Previous Statements:

Please indicate here any problems with previous statements (e.g. wrong name)

Any Other Information:

Attachment	Size
Statement_Of_Giving.docx	37.12 KB