| |
| |
| SEVA 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 |
| |
| |
Name |
|
| |
Address |
|
| |
|
|
| |
City |
|
| |
State |
|
| |
Zip/Pin
Code |
|
| |
Phone |
|
| |
E
mail |
|
| |
|
|
| Yes!
I would like to donate towards SEVA an amount of |
| |
Rs |
|
| |
Credit
Card Type |
|
| |
Date
of Expiry |
DD
M
Y
|
| |
Credit
Card No |
|
| Date of birth |
DD
M
Y
|
| |
Place |
|
| |
Date |
DD
M
Y
|
| Please
credit the said amount to " SEVA" |
| |
| Signature:
_____________________________ |
| |
| |
| Please
mail the form to the address below: |
| ……………cut here to use below
text as address label…………… |
| |
SEVA- Social Education and Voluntary Action
U. Raja Rao
H.No 11-24-36, M.V Colony
Road No -2, Deshaipet Road
Warangal, Andhra Pradesh, India
Phone :
Email : sevangowgl@rediffmail.com
|
