Personal Details

Declaration
In order to set up an online Direct Debit you must be the account holder of a personal bank or building society account and the sole required signatory on the account.

Details
*Title
*First Name
*Surname
*Contact No
Mobile No
Age verification (over 18s only)

*Date of Birth
*Email Address
*Confirm Email
Address
Enter postcode and optionally house number in address line1 then click 'Find Address'
*Postcode
*Address Line 1
*Town
County
* How did you hear about the Lottery?
Please Specify:


Marketing declaration:
By completing this form you are giving consent for Bury Hospice to use your data for administrative purposes related to running the lottery.

On the basis of legitimate interest we want to use your data to send you occasional information by post about our work, in order to help us continue care for local people, and their families. If you would prefer not to hear from us in this way, please tick:

We might also want to provide this information to you by email or phone. Please tell us if you are happy for us to do this.

You can change your preference at any time by contacting us via post, telephone or email.

Our Privacy Policy can be viewed at www.buryhospice.org.uk/privacy-policy
Payment Details
Bank Details
Bury Hospice
Rochdale Old Road
Bury
BL9 7RG
DDLogo

Email: lottery@buryhospice.org.uk

For any queries contact our Lottery Team on: 0161 763 1893

Is the account in your name? Are you the only signatory required to authorise this direct debit? If not, please contact the lottery office for a paper mandate which should be completed and sent to us with all necessary signatures.