Regular Automatic Payments Form or Single Donation Form
All donation over $2 are Tax Deductible.
If you would like to give a regular contribution to a project or give a single donation, please fill in the following details .
Supporter Number - ___________________________
Suburb: _____________________________ Postcode: ______________
Home No: ______________________________ Work No:_________________________
Email address: _____________________________________________________________
o I would like to give to Didier Martin's
campaign - 'Ride4Kids' which provides education and vocational training to
children and adults in Africa.
(MOT CODE - DC129G)
Amount to be donated (please tick)
Please deduct the total amount of $_______
as a o single donation. I have enclosed a cheque, or have filled in my credit
card details below.
I authorize World Vision to deduct regular payments of $___________ from my credit card until further notice, every -
o Month o 3 months o 6 months o Year
Once the form is complete please send it
World Vision - Michelle Gale
1 Vision Dve, Burwood East 3151.
1 Bankcard 1 Visa 1 MasterCard 1American Express 1Diners Club
Credit Card number::_ _ _ _ |_ _ _ _ | _ _
_ _ |_ _ _ _ | security Code _ _ _ _ |
(Your 3 or 4-digit Security Code is usually located next to your credit card number on the signature panel)
Signature: ________________________________ Expiry Date: _ _/ _ _
B) Payments by Direct Debit
If you would prefer to have your donation
deducted regularly from your bank, credit union or building society account,
we can easily arrange this. Please call Michelle Gale on (03) 9287 2335 to
arrange for this to occur