UJIA Donation Form

Other Amount*

Price

Which campaign are you supporting?

Other Campaign

Synagogue?

This donation is in memory of

This donation is to celebrate

How would you like to make this donation?

I would like to pay now by cardI would like to pay by Bank transfer / Cheque / OtherI would like to set up a direct debit

STRIPE: Campaign Name

Would you like to Gift Aid your donation? It’s free for you to do, and adds a further 25% to your donation?

Yes please, I am a UK taxpayer

Name*

TitleFirst NameLast Name

Phone Number

Email*

Address*

Street Address

Street Address Line 2

CityCounty

Postcode

Donor ID (if you know it)

Donation Type

Please send bank transfers to:

Acc Name: UJIA
Sort Code: 20-95-87
Account No: 70636657

Or send cheques, charity vouchers to:

4th Floor Amelie House, 221 Golders Green Road London, NW11 9DQ

I am happy for UJIA to Contact in future by:

EmailPhoneMailSMS

Card Payment*

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