Name/s

Address

Town

County / Postcode

Telephone

Credit Card No

    .                          .                           .

Expiry Date & 3 Digit Security No.

.

Signature

Email

 
Gift Aid Declaration Form

I wish the Chichester Cinema at New Park to reclaim tax on my donation
from today's date until I notify the cinema otherwise.

I am / am not   a UK taxpayer. (Delete as appropriate)

Name/s

Address

Town

County / Postcode

Telephone

Date

Signature

Post to:     Digital Appeal: Chichester Cinema at New Park,
New Park Road, Chichester, West Sussex PO19 7XY

If making your donation by cheque, please make it out to:
Chichester Cinema at New Park
Please send it to the address above or hand it in at the Box Office.