Application - North Staffs

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

Mailing flag

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

One Off Donation

Card number

Name on card

Optional Message

Donate Now

Donate

Donate to Emmaus North Staffs

Donation Summary

Your Details

Your Privacy

Stay in touch

Gift Aid

One Off Donation

Emporium closure