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KRUSHI Credit Card Payment Form |
Credit
Card Payment Form for VISA and MASTER card |
Please
fill in the form and print it before mailing to the
given address
below |
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Name |
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Address |
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City |
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State |
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Zip/Pin
Code |
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Phone |
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E
mail |
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| Yes!
I would like to donate towards KRUSHI an amount of |
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Rs |
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Credit
Card Type |
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Date
of Expiry |
DD
M
Y
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Credit
Card No |
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Date of birth |
DD
M
Y
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Place |
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Date |
DD
M
Y
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Please
credit the said amount to " KRUSHI" |
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| Signature:
_____________________________ |
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| Please
mail the form to the address below: |
……………cut here to use below
text as address label…………… |
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KRUSHI
7-8-80, Mankammathota,
Karimnagar - 505 001, (A.P.)
Andhra Pradesh, India.
Phone : 08722-48103
Email : krushingo@rediffmail.com, krushingo@yahoo.com
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