For any queries contact our Helpdesk No: 01522546500

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.

If you wish you can read the direct debit guarantee by clicking on the direct debit logo above.
Personal Details

House No/Name
*Account Address
*First Name
*Contact No
Mobile Tel No
*Date of Birth
*Email Address
*Confirm Email
Communication Preferences – Future Correspondence

Without the support of people like you, St Barnabas Hospice would not be able to provide the services that our patients need.

If you are happy for us to get in touch by email or text please tick the boxes below.

I agree St Barnabas Hospice can contact me by

As part of our legitimate interest we may write to you unless you inform us you want us to stop.

We will not share or sell your data and it will only be used for Hospice purposes to tell you about:

- Service and support information/updates, i.e. newsletters, changes to patient care services
- Fundraising such as appeals, events, gift aid, lottery and community initiatives
- Volunteering
- Retail
- Education and training

A copy of our latest privacy policy is available on our website and on request.

Please rest assured that your information is held in a secure manner and that you can update your preferences at any time by contacting our Supporter Care Team on supporter.care@stbarnabashospice.co.uk or 01522 540 300.
Payment Details
Bank Details