FILL OUT ALL DETAILS THEN PRINT OUT GIFTS/
DONATION
FORM A:
and submit by fax or post to nearest Creation Research Office below:
FORM
A
- GIFTS/
DONATIONS
DETAILS:
Please find my GIFT/DONATION by cheque
(payable to Creation Research)
OR charge my credit card (details below).
*
Date:
Day
-
1
2
3
4
5
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9
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31
Month
-
January
February
March
April
May
June
July
August
September
October
November
December
Year
-
2004
2005
2006
2007
2008
*
For the amount of:
*
Currency type eg.$us
*
Select method of payment:
Cheque
(payable to Creation Research)
Credit Card
(If ticked fill out
CREDIT CARD
details below)
DONOR DETAILS
*
Name:
Mr
Miss
Mrs
Ms
Dr
Rev
*
Address:
*
Suburb:
*
State/Province:
*
Country
*
Zip/Postcode
:
Work Phone:
AH Phone
Fax:
*
Email
WWW:
*
Date authorised:
Day
-
1
2
3
4
5
6
7
8
9
10
11
12
13
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
-
January
February
March
April
May
June
July
August
September
October
November
December
Year
-
2004
2005
2006
2007
2008
I AUTHORISE Creation Research to debit my
C
REDIT CARD details below
:
*
Name:
Mr
Miss
Mrs
Ms
Dr
Rev
*
Name on Card:
*
Card Type:
Select Payment Type
Visa
Mastercard
Bankcard
Call me for Card Details
I'll Fax Card Details
*
Card Number:
*
Expiry Date:
Month
-
01
02
03
04
05
06
07
08
09
10
11
12
Year
-
2004
2005
2006
2007
2008
C
OMMENTS (optional)
Comments
AUSTRALIA:
P.O. Box 260 CAPALABA Q. 4157. Ph. (07) 3206 4467 Fax. (07) 3206 0001
USA:
P.O. Box 281 Hartsville TN 37074. Voice Mail (615) 374 3693
CANADA
PO Box 31034, 15 Westney Road Nth. Ajax, ON L1T 3V2
Ph: (905) 686 7782 Fax: (416) 946 1678
NEW ZEALAND
PO Box 40480 Glenfield Auckland
Ph: (09) 476 8603 Fax: (09) 476 8605
UK:
P.O. Box 1 Ashton-U-Lyne Lancs. 0L6 9WW Phone/Fax. (0161) 282 1111
