Regular Automatic Payments Form or Single Donation Form
Ride4Kids
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….

name/Church/Company_________________________

Supporter Number - ___________________________

Address: __________________________________________________________

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.
OR
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 to-

World Vision - Michelle Gale
1 Vision Dve, Burwood East 3151.
AUSTRALIA

PAYMENT DETAILS

A) Credit Card

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: _ _/ _ _

OR
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

World Vision - Michelle Gale
1 Vision Dve, Burwood East 3151. AUSTRALIA
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DONATION FORM


Just print this form and send it to World Vision with your donation.
Actualy, why don't you print a couple more for your friends as well.