Donatieformulier

Support form

I support FOUNDATION FORSKA with:

Amount:

Naf or Euro

Manner of payment:

Multiple times
One time
Send me a Giro accept form

Account number: *

- Bank:

- Giro:

Name: *

Initials: *

Gender: *

Male Female

Address: *

Place of residence: *

Date of Birth : *

Telephone: *

E-mail address: *

Would you like to receive email notifications on how your donation is spent?

Yes No *

Concerning granting an authorization click on "print version" fill in this form, print it, sign and faxes to (5999)8888-697.

Signature

( Only necessary at an authorization )

...............................................................................

(Fields with * are obligatory form pay attention to, automatic authorization is for Curacaos bank only possible - or Post bank accounts)

Let op, automatische machtiging is alleen mogelijk voor Curaçaose bank- of girorekeningen!