Form - Cupcake Challenge

Money Return Form
#beatepilepsy
Cupcaked guests are expected to make a suggested donation of £5 each
Caley
Cupcak
Following your cupcake event you and your guests can make donations at:
JustGiving – www.justgiving.com/CharityCupcakeChallenge
Cheque or credit card – use the form below and send it with your donation to:
Muir Maxwell Trust Ltd, 1st floor, Suite 12, Stuart House
Musselburgh, East Lothian, EH21 7PB
Tel: 0131 273 5256
Title_________First Name___________________Surname ______________________
Address ______________________________________________________________
___________________________________________Postcode___________________
Email _______________________________Telephone__________________________
Total Raised _________________________Date of Event ________________________
Payment/Donation Details (please tick as appropriate)
I enclose a cheque made payable to Muir Maxwell Trust Ltd
I have made a payment at JustGiving – www.justgiving.com/CharityCupcakeChallenge
I would like to pay by credit/debit card. My details are:
Amex
Mastercard
Visa
Debit Card
Card No _______________________________________ Security Code __________
Start Date ______________ Expiry Date ______________ Issue number ___________
www.charitycupcakechallenge.com
www.muirmaxwelltrust.com
Scottish Charity No: SC035531
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