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Donate by Credit Card (Secure Order Form)

If you wish to make a credit card donation please fill in the form below. The information will be encrypted and sent by a secure server.

Fields with a * next to them must be completed.

Name: *
Email address:
Address Line 1: *
Address Line 2:
City/Town: *
Post Code: *
Country (please include this):
Credit card type *
Credit card number *
Credit card expiry date *
Amount £ *

Gift Aid Declaration (please tick as appropriate)

I confirm that I pay income tax in the UK.
I want the Association for Spina Bifida and Hydrocephalus to treat all donations I have made since 6 April 2000, and all donations I make from the date of this declaration until I notify you otherwise as Gift Aid donations.

I am a non-UK tax payer

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