St Vincent de Paul Society Donation Form |
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| [_] Yes, please accept my gift for the St Vincent de Paul Society. |
Please find enclosed my gift of:
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[_] $25 |
[_] $45 |
[_] $60 |
[_] $100 |
[_] $150 |
[_] $275 |
[_] Other $________ |
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| [_] |
Yes, I would like a receipt mailed to me.
Your receipt will be mailed to the postal address you provide below. Donations $2.00 and over are tax deductible. |
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| Name |
_____
(Title) |
____________________
(First name) |
_________________________
(Surname) |
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| Postal Address |
______________________________
(Address Line1) |
______________________________
(Address Line2) |
____________________
(Suburb) |
_________
(State) |
_________
(Postcode) |
______________________________
(Country) |
|
| Phone Numbers |
| H: ( ___ ) |
_______________ |
W: ( ___ ) |
_______________ |
|
| Email Address |
| __________________________________________________ |
|
| Age Group |
| [_] 10 - 17 |
[_] 18 - 24 |
[_] 25 - 39 |
[_] 40 - 54 |
[_] 55+ |
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| [_] |
My cheque / money order is enclosed, crossed 'Not Negotiable' and made payable to
'St Vincent de Paul Society'.
|
|
Or, please charge my credit card:
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[_] Visa |
[_] Mastercard |
[_] American Express |
[_] Diners Club |
|
| Number |
|__|__|__|__| - |__|__|__|__| - |__|__|__|__| - |__|__|__|__| |
Expiry |
____/____ |
Signature _____________________________ |
Please indicate by ticking the State you wish to make your donation to:
|
[_] NSW / ACT |
[_] NT |
[_] QLD |
[_] SA |
[_] TAS |
[_] VIC |
[_] WA |
|
Please send this form and your donation to your chosen St Vincent de Paul Society state office:
| NSW/ACT | PO Box 19, Petersham NSW 2049 | ABN: 46 472 591 335 001 |
| NT | PO Box 1468, Nightcliff NT 0814 | ABN: 11 300 386 527 |
| QLD | PO Box 3351, South Brisbane QLD 4101 | ABN: 14 211 506 904 |
| SA | GPO Box 1804, Adelaide SA 5001 | ABN: 73 591 401 592 |
| TAS | PO Box 407, Mowbray TAS 7248 | ABN: |
| VIC | Locked Bag 4800, Box Hill VIC 3128 | ABN: 28 911 702 061 |
| WA | PO Box 473, Belmont WA 6984 | ABN: 18 332 550 061 |
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| [_] Yes, I would like to know more about the direct debit donation program. |
| [_] Please send me more information on making a gift in my Will. |
| On December 21, 2001, the new provisions of the Privacy Amendment (Private Sector) Act 2000 commenced. This legislation updates the Privacy Act of 1988 and is designed to protect your rights with respect to personal information held. The St Vincent de Paul Society follows these national privacy principles. |
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