Please print, fill out, and senD

to 22 Victory Blvd, Ashburton VIC 3147

 

PLEDGE FORM

Yes! I want to support the Call of Guadalupe musical in promoting life and hope!

 

My gift today

$______  per month from the month of ______  to ______  OR $________ once off

Method of payment: Cash or Cheque / Money Order or Credit Card

 

Please debit the above amount from my:   MasterCard     Amex     Visa

Card No. _ _ _ _ /_ _ _ _ /_ _ _ _ /_ _ _ _     Expiry: _ _ / _ _

*Make all cheques/money orders payable to: Friends of COG Melbourne Inc., 22 Victory Blvd, Ashburton, VIC 3147

 

Name: ______________________________________________________________________________

Address: ____________________________________________________________________________

State: _______ Post code: ________ Mobile: ______________________________________________

Ph: (          ) __________________________ E-mail: __________________________________________

 

Office use only

AMOUNT RECEIVED: ____________________             CASH            CHEQUE           CREDIT CARD

Authorisation provided by Friends of COG-Melbourne Inc. No. A0046098R, ABN 96 857 733 724