:: Donation Form -- Shekinah Crusaders ::

Donate Form


SHEKINAH CRUSADERS 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"SHEKINAH CRUSADERS" 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 "SHEKINAH CRUSADERS"

Signature: _____________________________


Please mail the form to the address below:
"SHEKINAH CRUSADERS" Dr.P. Permanas M.A, LL.M, P.G.D.P.M Ph.D Honourary Director C1, Gulmohar Block, Amrutha Valley Rd No 12, Banjara hills, Hyderabad, India. E-mail : drpermanas@yahoo.com 91-40-23386988 (mobile) +91-9866550812

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