PLEDGE FORM - DOC by 5r6g27x

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									                            || Shri Gokulesho Jayati ||



                          PLEDGE FORM
            Goswamini Shrimati Parvati Vahuji Medical Trust
    Shrimad Vallabh Chaturpeeth, Shree Gokul, Mathura, U.P. 281303

       Jai Jai Shree Gokulesh
   General Hospital, Shrimad Gokul
NAME:       __________________________________________________


ADDRESS:          ______________________________________________




PHONE NO.         _________________ EMAIL:                __________________


SEVA/DONATION AMOUNT:                ________________________________
Make checks payable to: GSPVMT

Mail your check to:
Rajendra P. Kadakia
9 Tanbark Drive
Parlin,
NJ 08859
(732)-613-5068

Instruction from Donor:



        For further information on this hospital, please contact:
               Rajendra P. Kadakia
                    (732)-613-5068
             Email: kadakiar@optonline.net

								
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