Click & Give
Please print out this debit order form and send to us or your bank:
Fax +27 51 4333365 or post to: PO Box 28391, Danhof, Bloemfontein 9310, South Africa
Name -------------------------------------------------- ID No. -------------------------------------------------- Postal Adress: -------------------------------------------------- Residential Adress: -------------------------------------------------- I would like to donate R------------------------------------------ on the ------------------------- of each month Bank Name: ------------------------------------------ Debited to my account, nr: ------------------------------------------ Branch code ------------------------------------------
TO: NALEDI HOSPICE
ABSA BANK, code 630134
Acc. No. 404 564 2411Signature: -------------------------------------------------- Date: -------------------------------------------------- 
