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| Peace 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 PEACE 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 "Peace" |
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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………………………… |
PEOPLES ACTION FOR CREATIVE EDUCATION (PEACE)
Near S.LN.S Degree College
Bhongir - 5O8116
Dist: Nalgonda - A.P
Phone : +91-8685 - 242042
+91-98481-35479
Email : peace_ 16@sify.com
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