Donation Form - Shelterbox printable pdf download

DISASTER

RELIEF

Donation Form

Please send all donations to: ShelterBox Australia, PO Box 254, PARRAMATTA NSW 2124

o Please tick this box if you require a receipt to support a taxation deduction of your donation.

I would like to make a donation to support:

o ShelterBox - DONATION OF $__________

A ShelterBox can be sponsored for $1,000. Donations under $1,000 will be aggregated with others to fund a box and a tracking number will be assigned.

o The ShelterBox Solution - DONATION OF $__________

For the procurement of all types of ShelterBox aid to ensure vital equipment is sent wherever, whenever it is needed. No box number will be assigned.

TOTAL DONATION $__________

I learned about ShelterBox from ______________________________________________________________

Name________________________________________ Please keep my donations anonymous. o Yes

Address___________________________________City_________________State_____PostCode_________

Email___________________________________________Phone___________________________________

(Rotary/Rotarians ONLY): District _____________ Rotary Club Name_________________________________

Method of payment:

o Cheque - Please make payable to ShelterBox Australia

o EFT - Westpac BSB: 032 189 Acc: 230 147.

Note deposit clearly and/or email to advise to .au

o Visa

o MasterCard

o AMEX

o Card Number_________________________

Name on card ___________________________ Expiry Date _________ CVV2 ____

(last 3 digits on the back)

Signature ________________________________

Tribute Options - please make my donation: In Honour of o In Name of o In Memory o Tributes

Name_____________________________________________________________________________

Please send a notification to

_____________________________________________

(please provide address)

Recurring Donation Options:

(All recurring donations must be set up using a Visa/MasterCard/AMEX credit card or debit card)

I would like to set up recurring gifts in the amount of $_________on a monthly basis o annual basis o

I hereby give permission for ShelterBox Australia to debit my credit card on a recurring basis per the information marked above.

Print Name________________________________Date_______Signature______________________

DISCLAIMER TO DONORS

ShelterBox Australia will only distribute aid on the basis of need and within safe and achievable operating parameters.

Location-specific and/or time-specific donations cannot be honored.

Donors who sponsor a ShelterBox will receive a unique tracking number. The value of a box sponsorship includes the cost of the box, its life-

saving contents, its transportation and the training and deployment of volunteer ShelterBox Response Teams.

ShelterBox Australia | PO Box 254, PARRAMATTA NSW 2124 | P 1300 996 038 | F 02 9891 5984 | ABN 21 143 129 220

Donation Form - Shelterbox