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DONATE BY MAIL

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					DONATE BY MAIL

Here is my/our donation to help the Emerald Hill Mission help the needy communities within
the Cities of Melbourne and Port Phillip and the Central Business District.


Contact Information

Courtesy Title (please circle)

Mr                Mrs             Ms

First Name: ………………………………………………………………………………………….

Last Name: …………………………………………………….…………………………………….

Address:       …………………………………………………….…………………………………….

City/Town:    …………………………………………………….…………………………………….

State: …………………                   Post Code: ………………………

Country:       …………………………………………………….…………………………………….

Phone – Home: ……………………………………………………………………………………….

Phone – Work: ………………………………………………….…………………………………….

Phone – Mobile: ……………………………………………………………………………………….

Email Address: …………………………………………………..…………………………………….




My/our donation payable to the Emerald Hill Mission, Inc. is enclosed as follows:


$    …………………………………………………….


Cheque                    Money Order

(Please circle)


OR

(Credit card option overleaf)


                                      Emerald Hill Mission, Inc.
    377 Dorcas Street South Melbourne Postal Address PO BOX 3062 South Melbourne Victoria 3205
         Telephone (03) 9682 9600 Fax (03) 9696 3730 E-mail chris@emeraldhillmission.org.au
                                ABN 88 459 948 179 DGR 900472887
Please charge $   ………………………………………………… to my credit card:

Card Type: …………………………………………………….

Card Number: …………………………………………………….

Expiry Date: …………………………………………………….

Signature: …………………………………………………….

Monthly contributor:    Yes     No      (Please circle)

Please charge $ ……………………………………………………. monthly to my credit card
above until I/we advise other.




Please print this form with your details completed and mail with your Cheque or Money Order
to:

Emerald Hill Mission
PO Box 3062
South Melbourne
Vic 3205


Thankyou for your support!




                                    Emerald Hill Mission, Inc.
  377 Dorcas Street South Melbourne Postal Address PO BOX 3062 South Melbourne Victoria 3205
       Telephone (03) 9682 9600 Fax (03) 9696 3730 E-mail chris@emeraldhillmission.org.au
                              ABN 88 459 948 179 DGR 900472887

				
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