Application - Leicestershire & Rutland

Your Details

Fields marked * are mandatory

Title *

First Name *

Last Name *

Email *

Phone Number *

Address Line 1 *

Address Line 2

Address Line 3

Town / City *

Country *

Postcode *

Your Privacy

Your email address will be used to confirm payment, but we would also like to communicate with you via email by sending you updates and fundraising appeals.

Stay in touch

Agree

I am happy for Emmaus UK to contact me by post, with updates and fundraising appeals to keep me up to date with the work Emmaus is doing across the UK.

email opt-in

Agree

I am happy to receive a monthly e-newsletter from Emmaus UK. You can change these preferences at any time by contacting [email protected] or calling 0300 303 7555

Gift Aid

Boost your donation by 25p of Gift Aid for every £1 you donate Gift Aid is reclaimed by the charity from the tax you pay for the current tax year.

Do you want to Gift Aid your donation and any donations you make in the future or have made in the past 4 years to Emmaus UK?

I am a UK taxpayer and 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 tax year it is my responsibility to pay any difference.

If this donation has been collected from a third party; for example; at a fundraising event, from a friend or family member, a sweepstake or raffle, or is being made on behalf of a company, we are unable to claim any Gift Aid on this donation.

Gift Aid *

Yes
No

Monthly donation

Account number *

Sort Code *

Account name *

Which day of the month would you like the direct debit to be on?

1st
15th

Your first donation will be collected on the next available direct debit date which occurs after 20 days from today.

The Direct Debit Guarantee

The Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits. If there are any changes to the amount, date or frequency of your Direct Debit Emmaus UK will notify you (normally 10 working days) in advance of your account being debited or as otherwise agreed. If you request Emmaus UK to collect a payment, confirmation of the amount and date will be given to you at the time of the request. If an error is made in the payment of your Direct Debit, by Emmaus UK or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society If you receive a refund you are not entitled to, you must pay it back when Emmaus UK asks you to. You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.

Service user number: 289671

Declaration *

I wish to start a Direct Debit

Optional Message

Donate Now

Donate

Donate to Emmaus Leicestershire & Rutland

Donation Summary

Your Details

Your Privacy

Stay in touch

Gift Aid

Monthly donation

The Direct Debit Guarantee

Charity Skydive for Emmaus 2025

Donate to Emmaus Leicestershire & Rutland

Donation Summary

Your Details

Your Privacy

Stay in touch

Gift Aid

Monthly donation

The Direct Debit Guarantee