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AGREEMENT To Nesin Foundation
I read and
understood the humanitarian purposes of the Nesin Foundation and
I am aware of its activities. To support the Nesin Foundation, starting
from (dd/mm/yy) ___ / ___ / ___ I agree to make monthly donations
of _______ USD per month for ___ years and ___ months. Signature Date : ___ / ___ / _____
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| Name : | ________________________ |
| Work Address and Phone : | ____________________________________________ ____________________________________________ |
| Home Address and Phone : |
____________________________________________ ____________________________________________ |
| e-mail : | ________________________ |
| Fax : | ________________________ |
| Credit Card : | Mastercard |
| Visa | |
| Eurocard | |
| American Express | |
| Credit Card Number : | _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _ |
| Expiration Date : | ___ / ___ |
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Signature : |
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