| Please fill in the form below, print and post. Thank you. | ||||
| donating to Jambula Childrens Centre. | ||||
| I hereby authorize the above organisation to withdraw a the stated amount of money from my account. This authorization is valid until I personally inform the organisation to cancel it. (Hiermit ermaechtige ich die oben genannte Organisation, Geld aus meinem Konto einzuziehen. Die Einzugsermaechtigung gilt, bis ich diese Vereinbarung schriftlich kuendige.) | ||||
| Which prject would you like to sponsor? | ||||
| Name of Project: | ||||
| Account Information / Bank Verbindung | ||||
| Firstname | ||||
| Lastname | ||||
| Bank Code / Blz | ||||
| Bank | ||||
| Ac. No. / K. Nr. | ||||
| Amount | ||||
| 500 Euro | 1000 Euro | 5000 Euro | ||
| $ 500 | $ 1000 | $ 5000 | ||
| 500 Pounds | 1000 Pounds | 5000 Pounds | ||
| Other | (please specify the currency. | |||
| Private Address / Privat Adresse | ||||
| Street / Strasse | ||||
| Postal Code / Plz | ||||
| State / Stadt | ||||
| Country / Staat | ||||
| Tel. No. / Tel. Nr. | ||||
| Confirmation / Bestaetigung | ||||
| Place
/ Ort
__________________________________ |
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| Date
/ Datum
________________________________ |
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| Signature
/ Unterschrift
________________________ |
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| Our Mailing Adress / Unsere Adresse | ||||
| Jambula Kinder Verein | ||||
| Orphans Sponsorship | ||||
| Neckaraeurstr. 217 | ||||
| 68199 Mannheim | ||||
| Germany | ||||