Card transactions - Ileostomy & Internal Pouch Association

Card transactions - Internal Use Only

This form enables you to take card payment over the phone. An email will be automatically triggered where the payment is successfully process; one to the email account provided as a payment receipt and another to the email provided with details of the payment based on what are entered into the form. Please enter the description carefully to ensure it is meaningful to the recipient.

Email
This field is for validation purposes and should be left unchanged.
Gift Aid Eligible?

The member must be a UK taxpayer and eligible to Gift Aid (pay at least the equivalent in UK tax as is being claimed by IA in that tax year), IA can claim an extra 25p for every £ given, to support its charitable activities
- IA can claim Gift Aid on membership subscription payments where they are paid by the member only
- IA can claim gift aid on voluntary donations
- IA cannot claim Gift Aid on paid events or for any paid services
- Must provide a gift aid declaration to allow IA to claim (can be sent via the post or download from IA’s website)
Cardholder name*
Cardholder billing address*
Address 1 Address 2 Town / City County / State / Region Postcode Country
Cardholder contact number
Cardholder email address
Enter Email Confirm Email
Reason for payment*
- Membership
- Membership and donation
- Donation
- Information Day
- Internal Pouch event
- Other
This field is hidden when viewing the form
Event details*
Where reason is 'other', please indicate the reason for payment.
Comments
Optional for anything further to support reason for payment
Membership Cost
Amount to charge*
e.g. donation amount, event amount. Membership cost for membership related payments
Total
£ 0.00
Credit / Debit Card*
Card Details
Cardholder Name

Card transactions - Internal Use Only

Gift Aid Eligible?