FAX DONATION FORM

• SELECT YOUR PREFERRED CURRENCY
• PRINT THIS PAGE
• FILL IT OUT
• FAX IT TO YOUR PREFERRED MERF BRANCH (LISTED BELOW)

My gift will be in: Select currency USD American $ CAD Canadian $ AUD Australian $ NZD NewZealand $ GBP British Pounds IEP Irish Punt DEM German Marks FRF French Francs NLG Dutch Guilders XEU Euro $ CHF Swiss Francs ITL Italian Lira JPY Japanese Yen SGD Singapore ZAR Sth Afr. Rand SEK Swedish KR OTHER ___________

NAME _______________________EMAIL_____________________

ADDRESS ______________________________________________

POST CODE _________________ COUNTRY __________________

CHURCH _______________________________________________

PHONE ______________________ FAX _____________________

[____] Where most needed [____] Training Converts [____] Arabic Literature [____] Radio Evangelism [____] Training Leaders [____] Church Planting

[____] National Evangelism [____] Relief Aid [____] Study Centre [____] Field Workers [____] Other: ___________________

[_] I enclosed cheque/money order for _________

[_] Please deduct _________ from my

[_] Visa [_] Mastercard [_] Bankcard

(Processing of credit card contributions is only available from the USA and Australia at this time.)

CARD No: |__|__|__|__|-|__|__|__|__|-|__|__|__|__|-|__|__|__|__|

Expiry date: __/__ Todays Date: __/ __/___

Signature : X_________________________

For ongoing support commitment:

[_] Please deduct _________ from my credit card each month until further notice.

Date:__/ __/___ Signed ___________________

---

MERF WORLDWIDE FAX DIRECTORY

 

MERF New Zealand Fax: +64 9 537 4818

MERF USA Fax: +1 616 786 4887