Your details Title* First Name* Last Name* Address Search Address City County Postcode Country HollandGermanyFranceUnited KingdomItalySpain Phone Email* Payment details Amount*£ Card Number* Credit Card* VisaMasterCardAmerican ExpressDiners ClubDiscoverJCB Expiry Date (mm/yy)* / Security Code* I would like to make this gift*A One OffAn Ongoing Commitment to Help I would like to donate*MonthlyQuarterlyAnnually Comments Gift Aid Yes I would like you to claim Gift Aid on my donation I want all donations I've made to you in the past four years and all donations in future to be treated as Gift Aid donations until I notify you otherwise. I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference. We will claim 25p on every £1 you donate. We’ll use your details to contact you about your donation, but we’d also like to keep in touch with you about our vital work and fundraising activities. Let us know if you would like us to keep in touch using the following methods: EmailPhone There is a problem with your payment - Please wait ... You can change your preferences by emailing email@example.com or calling 020 7758 0660. To find out how we keep your details safe, see our privacy statement Samaritans is made up of branches across the UK, the Republic of Ireland, the Channel Islands and the Isle of Man, some of which are registered as independent charities. Your information will only be used for the purposes of Samaritans and its branches.