Direct Debit | Action Medical Research

Direct Debit

Your donation can help save and change children's lives

* All fields marked with an asterisk must be completed
Donation options
I wish to give £ a month by direct debit *

Gift Aid your donation

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. Your address is needed to identify you as a current UK taxpayer.

* I confirm that I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all my donations it is my responsibility to pay any difference.

Please notify us if you want to cancel this declaration, you change your name or home address, or if you no longer pay sufficient tax on your income and/or capital gains.

If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code.

Name and address
Bank or Building Society details

In order to set up a Direct Debit instruction online, you must be the account holder of a personal bank or building society account. If you are NOT the only required signatory on your account you can download the printable PDF version of the Direct Debit form here.

View the Direct Debit Guarantee

Join our fight for little livesThanks for your donation today. We'd like to keep you updated on how your support is helping save and change children's lives and to let you know how you can help and support in the future. If you're happy to hear from us by email, phone or SMS please tick the boxes below to let us know
You can change how you hear from us at any time. As a supporter of Action we will keep you updated by post but if you'd rather not hear from us in this way, please let us know by emailing or by calling us on 01403 210406. We will always keep your details safe and secure and will not sell or swap your details with anyone. You can read our full Privacy Policy or call the number above to receive a copy in the post.
What prompted you to make a donation

By clicking 'Complete >' I confirm that I am the sole named account holder for the above and am happy for Action Medical Research to set up the Direct Debit Instruction.

Secure Payment

We want to reassure you that by working with the best partners like Thawte we'll keep your data safe.

Contact Us

If you have any question about giving a donation please give us a call on 01403 210406

Other ways to pay

Telephone 01403 210406

Post Download Form

Action Medical Research is a member of the Fundraising Standards Board

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