Student Saver Donation £15 Payment can be made by: CARD, CASH or CHEQUE (we only accept school / group BUSINESS cheques) Name (School / Group / Individuals: First & Surname) …………………………………………………………………………………………………………… Address:....................................................................................................................................................................................... ....................................................................................................................................................................................................... ...................................................................................................................................................................................................... Post Code:.................................................................................................................................................................................... Telephone:…................................................................................................................................................................................. Email: ........................................................................................................................................................................................... How did you hear about us? …….................................................................................................................................................. Groups / Schools: Approximate number of members / pupils & staff? ............................................................... 1.
Have you read the terms and conditions of membership and do you agree to abide by them? Dorset Scrapstore Terms & Conditions
Please tick YES…[_] NO… [_]
2.
Dorset Scrapstore is a charity that relies on your donations. They are used to pay for our premises, run our van and pay the salaries of our two employees. Do you agree to donate at least £4 per bag of scrap collected?
YES…[_] NO… [_]
Do you agree to the information given on this form being held on the Scrapstore database? This is for our own information and will not be shared with any third parties.
YES…[_] NO… [_]
a) Individuals – Will materials taken be only for personal or family use? b) Groups / Schools - Will materials taken be purely for educational or recreational purposes?
YES…[_] NO… [_]
Schools and Groups only: Does your organisation have Third Party Insurance? (not applicable if materials are for personal use)
YES…[_] NO… [_]
3.
4.
5.
6.
Individuals only - Do you agree to Dorset Scrapstore claiming Gift Aid on your behalf? Please see full declaration overleaf.
YES…[_] NO… [_]
Please note that membership information is now kept electronically; we check your details on arrival at the store. Membership cards are available on request in store only.
Date ........................................................................................
Contact Name ……………………………………………………………… Position ……………………………………………………………………………. Groups - up to four other people in your group can be named to use the Scrapstore. Groups – up to four people in your group can be named users. Please state below: User 1. ……………………………………………………………......
User 3. ……………………………………………………………………………………
User 2. ………………………………………………………………….
User 4. ……………………………………………………………………………………
Dorset Scrapstore Registered Office: The Factory | 14 Alder Hills | Poole | Dorset | BH12 4AS Registered in England | Company Number 3870643 | Registered Charity Number 1081569 www.dorsetscrapstore.org.uk
Individual Gift Aid Declaration – for past, present and future donations I confirm that I have paid or will pay an amount of Income Tax/Capital Gains Tax for each tax year (6 April to 5 April) that is at least equal to the amount of tax that all the charities or Community Amateur Sports Groups (CASCs) that I donate to will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand the charity will reclaim 28p of tax on every £1 that I give on or after 6 April 2008. Please treat as Gift Aid donations all qualifying gifts of money made: today [ ] in the past 4 years [ ] in the future [ ] (please tick all boxes you wish to apply) By signing below I agree to Dorset Scrapstore claiming Gift Aid on all donations, including but not limited to Membership and bags of scrap. Signature ...........................................................................
Date .......................................................................................
Dorset Scrapstore Registered Office: The Factory | 14 Alder Hills | Poole | Dorset | BH12 4AS Registered in England | Company Number 3870643 | Registered Charity Number 1081569 www.dorsetscrapstore.org.uk
