PROYECTO VISIÓN
Name Family name
Address City
Postal Code Province Country
Telephone Fax E-mail
Amount donated Frequency: yearlysix monthsquarterlymonthlyonce only
I wish to stablish contact in a personal meeting
FORMS OF PAYMENT
Direct debiting to Bank account no.
Bank transfer to "laCaixa" cta. 2100 3136 42 2200171187
Credit card: Expiry month 1 2 3 4 5 10 Year 2007 2008 2009 2010 2011 2012 Conforme
Please state your comments or queries if desired
NATIONS HAVE A 25% TAX RELIEF
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