Please complete the whole form using a black ball point pen
and return to:
FREEPOST RTEK–LRUA–ULTA, Magpas Air Ambulance,
Centenary House, St Mary’s Street, HUNTINGDON PE29 3PE
Bank/building society account number
Name(s) of account holder(s)
Branch sort code
Name and full postal address of your bank or building society
To The Manager Bank/building society
The Direct Debit Guarantee
Please detach and keep the Direct Debit Guarantee safe for your records
The Guarantee is offered by all banks and building societies that accept
instructions to pay Direct Debits
If there are any changes to the amount, date or frequency of your Direct Debit
MAGPAS will notify you 10 working days in advance of your account being debited
or as otherwise agreed. If you request MAGPAS to collect a payment, conrmation
of the amount and date will be given to you at the time of the request
If an error is made in the payment of your Direct Debit, by MAGPAS or your bank
or building society, you are entitled to a full and immediate refund of the amount
paid from your bank or building society
If you receive a refund you are not entitled to, you must pay it back when MAGPAS
asks you to
You can cancel a Direct Debit at any time by simply contacting your bank or
building society. Written conrmation may be required. Please also notify us.
Instruction to your Bank or Building
Society to pay by Direct Debit
4 3 9 8 3 3
Service user number
Please tick the amount you would like to be debited from your account
1 chance a week (1 ticket)
An initial payment of £6.34
then £4.34 monthly
£13 quarterly
£26 half yearly
£52 yearly
2 chances a week (2 tickets)
An initial payment of £12.68
then £8.68 monthly
£26 quarterly
£52 half yearly
£104 yearly
Your subscription will start at the earliest available date.
Instruction to your bank or building society
Please pay MAGPAS Direct Debits from the account detailed in
this Instruction subject to the safeguards assured by the Direct
Debit Guarantee. I understand that this Instruction may remain
with MAGPAS and, if so, details will be passed electronically to
my bank/building Society.
Keep in touch
Your support makes a lifesaving difference and we’d love to keep you
up to date with the work you are helping to fund (including updates
and our latest campaigns). If you would like to stay in touch then
please let us know the best way(s) to contact you by ticking below:
You can change how we communicate with you at any time by
contacting or calling 0300 321 4971.
Alternatively, you can write to us at Magpas Air Ambulance, Centenary
House, StMary’s Street, Huntingdon, PE29 3PE. More information can
be found on our privacy statement at
You will receive a copy of your Welcome Pack and Direct Debit
Guarantee in the post within the next 10 working days.
My details
First name
Consent to play
IMPORTANT: I conrm I am over the age of 16
Banks and building societies may not accept Direct Debit Instructions
for some types of account
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