St Luke's - Direct Debit Sign Up

St Luke's Hospice
Little Common Lane
Sheffield
S11 9NE
0114 2357 595
lotteryoffice@hospicesheffield.co.uk

Direct Debit Sign Up - St Luke's Lottery

For any queries contact our Helpdesk No: 0114 2357 595
You will need your account details, which can be found on your cheque book, to complete the direct debit instruction. Is the account in your name? Are you the only signatory required to authorise this direct debit?
If not, please click here for a paper mandate (PDF format) which should be printed off and sent to us with all necessary signatures. If you do not have Adobe PDF Reader please click here to download it.

Please complete the following information:

Personal Details...

Title:	*
Forename(s):	*
Surname:	*
House Number/Name:	*
Post Code:	*
Telephone Number:	*
Mobile Number:
E-Mail:	*
Date of Birth:	format ddmmyyyy optional
I confirm that I am over 16 years of age:	*	You must be over 16 years of age to participate in this lottery
Sex:
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Why are you supporting St Luke's Hospice?	*

Debit Details...

Number of Lottery Tickets
Payment Frequency:
Payment Amount £:		Calculated based on number of tickets and payment frequency
First Payment Date :

Bank Details...

Account Name:

Sort Code:

Account Number:

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If you wish you can read the Direct Debit Guarantee by clicking on the logo to the left, it is also displayed at the end of the sign up.