Thank you for choosing to be a regular supporter. Please complete the form below and you will shortly receive confirmation of your direct debit instruction by email.

Please complete the forms below to authorise your Direct Debit.

Alternatively: If you are not the only required signatory on your account, or you would rather send us a paper version of this form, click here (PDF file - you will need a copy of Adobe's Acrobat software to read this file - you can download this software for free.)

I would like to become a supporter of ASH Scotland and make a regular donation of:  

£6
£24
Other

£  Per  Starting    

Suggested donation is a minimum of £6 every quarter or £24 annually to directly support our vital campaign work

Title  
First name*      * denotes a required field.
Initials  
Surname*  
     
Postcode*  
     
Address 1*  
Address 2  
Address 3  
Town*  
County / Area  
Country  
     
     
Telephone number* UK Telephone Land Line Only (No Spaces)
Mobile number UK Mobile Number Only
e-mail*  
 


Direct Debit Logo

Instruction to your Bank or Building Society to pay by Direct Debit

8 Frederick Street,
Edinburgh,
EH2 2HB 0131 225 4725
Service user number:
Reference:
(To be completed by ASH Scotland)
   
*Name of account holder(s)
* Sort code
*Account number
(Bank/Building Society)
   
NOTE: Your account number and sort code will identify your bank and branch address.
Instructions to your Bank or Building Society to pay by Direct Debit.

Please pay ASH Scotland Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with ASH Scotland and if so, details will be passed electronically to my Bank/Building Society.

NOTE: Banks and Building Societies may not accept Direct Debit Instructions for some types of accounts.

09 Jun 2026



  • This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.
  • If there are any changes to the amount, date or frequency of your Direct Debit ASH Scotland will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request ASH Scotland to collect a payment, confirmation of the amount and date will be given to you at the time of the request.
  • If an error is made in the payment of your Direct Debit, by ASH Scotland or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society
  • If you receive a refund you are not entitled to, you must pay it back when ASH Scotland asks you to.
  • You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.


Additional Questions

Please tick here if you would like ASH Scotland to reclaim the tax on any donations that you make through the Gift Aid scheme. In order for ASH Scotland to reclaim the tax you have paid on your donations, you must have paid income or capital gains tax (in the UK) equal to the tax that will be claimed (currently 28p for each £1 you give).



*Check Authorisation
Please check this box to confirm that you are authorised to submit this Direct Debit agreement.

^ back to top