11 Greenvale Road Eltham, London SE9 1PB

Registered Charity No. 1166920

Telephone: 020 3732 6359 Email: info@nolostpotential.org.uk

Customer Ref:


Until further notice

Payment Information

Payment Day:
First Payment Date:
01 December 2020
I wish to pay a regular Direct Debit of:

Personal Details


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

Eazy Collect Re No Lost Poten, 11 Greenvale Road, Eltham, London, SE9 1PB

Service User Number:


Checking the box indicates that I am the Bank/Building Society holder and no authority other than my own is required. If more than one person is required to authorise debits from the account, you are unable to setup a direct debit online.


You can cancel your monthly donation subscription at any time. There is no contractual obligation to remain for a period of time. Termination will take effect immediately although any funds which have been collected at the point of termination are non-refundable.

Click here to print Direct Debit form


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