Make a donation to Withington Community Hospital Donation Information Amount: £ 5.00 £ 10.00 £ 20.00 £ 50.00 £ 100.00 Other £ * Designation: Donation to Withington Community Hospital Other Other * Additional Information Frequency: Weekly Monthly Quarterly Annually On: Sunday Monday Tuesday Wednesday Thursday Friday Saturday Starting: Ending: Ending: Corporate: This donation is on behalf of a company Reason for donation: Gift Aid: I am a UK taxpayer and would like Manchester University NHS Foundation Trust (MFT) Charity to treat all donations I have made in the last four years and all donations I make in future as Gift Aid donations. I have paid income tax and/or capital gains tax for each tax year at least equal to the tax you, and all other charities and Community Amateur Sports Clubs (CASCs) that I donate to, reclaim on my donations for that tax year. I understand that VAT and Council Tax do not qualify. What is Gift Aid? Company address details (if applicable): Receipt: I accept I will receive my receipt by email I prefer to receive a receipt by post Communication Preferences We want to keep in contact with you, but need your permission to do so. Please let us know how you would like to hear from Withington Community Hospital Charity Communication Type Opt-in Opt-out I am happy to receive charity e-news I am happy to receive telemarketing I am happy to receive text messages Billing Information (cardholder's details) Title: <Please select> Dr Father Judge Madam Master Miss Mr Mrs Ms Professor Reverend Sir * First name: * Surname: * Country: Australia Austria Canada Chile China Cyprus France Germany Hong Kong Ireland Italy New Zealand Norway Portugal South Africa Spain Sweden Switzerland The Netherlands United Blackbaud United Kingdom United States * Postcode: * Address lines: * City: * County: Kingston upon Thames Aberdeenshire Anglesey Angus Argyll Avon Ayrshire Banffshire Bedfordshire Berkshire Buckinghamshire Caithness Cambridgeshire Carmarthenshire Channel Islands Cheshire Clackmannanshire Cleveland Clwyd Conwy Cornwall County Antrim County Armagh County Donegal County Down County Fermanagh County Kildare County Londonderry County Meath County Tyrone County Wexford County Wicklow Cumbria Denbighshire Derbyshire Devon Dorset Dumfrieshire Dunbartonshire Durham Dyfed East Lothian East Midlands East Sussex East Yorkshire Essex Exeter Fife Flintshire Gloucestershire Greater London Greater Manchester Guernsey Gwent Gwynedd Hampshire Herefordshire Hertfordshire High Peak Inverness-Shire Isle of Man Isle of Wight Jersey Kent Kincardineshire Kinross-Shire Kirkcudbrightshire Lanarkshire Lancashire Leicestershire Lincolnshire London Lothian Merseyside Middlesex Midlothian Monmouthshire Morayshire Nairnshire Norfolk North Humberside North Lincolnshire North Tyneside North Yorkshire Northamptonshire Northumberland Nottinghamshire Orkney Oxford Oxfordshire Peeblesshire Pembrokeshire Perth and Kinross Perthshire Powys Renfrewshire Shropshire Somerset South Glamorgan South Gloucestershire South Humberside South Lanarkshire South Wirral South Yorkshire Staffordshire Stirlingshire Suffolk Surrey Sussex Tyne & Wear Warwickshire West Glamorgan West Lothian West Midlands West Sussex West Yorkshire Wigtownshire Wiltshire Worcestershire Yorkshire County Durham Mid Glamorgan Tyne And Wear N/A Stockport Queensland USA Co.antrim West Glam Lancs SWITZERLAND Dumfriesshire South Glam Chester Roxburghshire Rodopi Phone: * Email: * Payment Information Cardholder's Name: * Credit Card Number: * Card Type: Visa Discover Maestro MasterCard * Valid From: 01 02 03 04 05 06 07 08 09 10 11 12 / 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 (Maestro/Switch/Solo only) Card Expiry: 01 02 03 04 05 06 07 08 09 10 11 12 / 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 * Issue Number: (Maestro/Switch/Solo only) Card Security Code: * Note: The Card Security Code is not required for Maestro, Switch and Solo cards.