orphan sponsorship by mlw38496

VIEWS: 0 PAGES: 1

More Info
									                                                  P.O. BOX 4916, Silver Spring, MD 20914
                                                  Tel. (301) 236-0233 FAX (703) 995-0369
                                                               www.mafiq.org


Orphan Sponsorship Form

                                                                       1. Sponsor Information

Name:
                         (Last name)                                              (First name)                                                       (MI)


Spouse:
                         (Last name)                                              (First name)                                                       (MI)

Address:
                                                  (Street)                                                                                           (Apt.)



                                        (City)                                       (State)                                                       (Zip Code)


Telephone:                                                                                 E-mail:

                                                                   2. Sponsorship Information
Please circle the number of                 have selected the following
                                          I I have selected the following orphans names of orphans for sponsorship:
                                                                                  for sponsorship: (Please print the names)
orphans you want to                       1. ____________________________         5. ____________________________
sponsor      1     2  3.                  2. ____________________________         6. ____________________________
. 4. 5        6     7  8.                 3. ____________________________         7. ____________________________
…………………..                                 4. ____________________________         8. ____________________________

 Begin Sponsorship as of (Date): ______/______/______________
                                                 Month     / Day              /    Year




                                                                      3. Payment Information
Sponsorship donation is only $35 per month for each orphan. Sponsorship donation is subject to change for adjustment against inflation
and living cost rises. Current sponsors will be notified prior to making any adjustment in sponsorship donation. All donations to Mafiq
Foundation are tax deductible. Our Tax ID #52-2237719.

Payment Period:                  [ ] Monthly                            [ ] Semi Annually                         [ ] Annually          [ ] Other _____________

Payment Method:                  [ ] Check                              [ ]Credit Card                     [ ] Automatic Bank Withdrawal

Payment Amount : _______________________
                         (Please multiply number of orphans selected by sponsorship fee for each orphan)



Payment by Check                             Please mail your check to: Orphan Sponsorship Program, P.O. BOX 4916, Silver Spring, MD 20914


Payment by
                                 Card Number: ______________________________________________                                     Exp Date: _____/_______
Credit Card
                                 Name on the Card: _______________________________________________________________


Payment by
                                 Bank Account Number : _____________________________________________________________________
Bank Draft
(Please attach a voided check)
                                 Bank Name: ______________________________ Routing Number: ___________________________________



The undersigned authorizes MAFIQ Foundation to debit my bank account or charge my credit card
account according to the period and amount specified herein. I understand that I have the sole right
to cancel future charges in my account by notifying MAFIQ Foundation in writing 30 days prior to
the due dates of such charges.


Signature: __________________________________________________ Date: _____________________

								
To top