Donate to Parkinson's - Credit/Debit Setup Request Form

Front Page | - USE THIS FORM TO CONTACT US TO SET UP DEBIT OR CREDIT CARD PAYMENT(S) -
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We will contact you upon receipt of this form.

Any information you give will be treated as confidential and will not be used for any other purpose.	Parkinson's Association of Ireland Carmichael Centre North Brunswick Street Dublin 7.	Extra Information Extra Information:

YOUR DETAILS:
Name: (Required)
Address:
Email Address:
Phone Number:

Please send me a debit/credit card form. 1. If you wish to know more about the work of the Association, or are interested in membership, please tick here 2. If you would like to assign your donation to a particular branch, or the main office, or for a particular purpose, please write in the Extra Information textbox above! 3. We can claim Tax Relief on individual donations over €250 (€21 per month) given within the Tax year at no extra cost to you. Tax relief - if you are a PAYE taxpayer - is applied at the marginal rate and is paid directly by the Revenue Commissioners to the eligible charity or approved body, on receipt of the appropriate certificate. Please tick here if you would like to help us in this way!