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| Priyadarsini Service Organisation Credit Card
Payment Form |
| Credit Card Payment Form for VISA
and MASTER card |
Please fill in the
form and print it before mailing to the
given address below |
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Name |
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Address |
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City |
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State |
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Zip/Pin
Code |
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Phone |
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E
mail |
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| Yes!
I would like to donate towards PRIYADARSINI SERVICE ORGANISATION an amount of |
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Rs |
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Credit
Card Type |
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Date
of Expiry |
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Credit
Card No |
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| Date
of birth |
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Place |
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Date |
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| Please credit the said amount to " PRIYADARSINI SERVICE ORGANISATION" |
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| Signature:
_____________________________ |
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| Please
mail the form to the address below: |
