| Credit Card Form |
Payable to RASIT Account
Please charge the following account for:
Amount to donate: USD
Mastercard Visa
Card Number:
Expiry Date: Security Code:
Cardholder’s Name:
Cardholder’s Address:
Tel: (wk)
(hm)
Cardholder's signature:
Your signature on this form authorizes RASIT to charge your account for the actual Donation
mentioned. You will receive a receipt showing the actual donation contributed.
Please Print and send this form via Fax or Mail.
Fax No.: USA (201)-340 4264
Mailing Address: PO Box 1557, Rutherford, NJ 07070, USA
Please charge the following account for:
Amount to donate: USD
Mastercard Visa
Card Number:
Expiry Date: Security Code:
Cardholder’s Name:
Cardholder’s Address:
Tel: (wk)
(hm)
Cardholder's signature:
Your signature on this form authorizes RASIT to charge your account for the actual Donation
mentioned. You will receive a receipt showing the actual donation contributed.
Please Print and send this form via Fax or Mail.
Fax No.: USA (201)-340 4264
Mailing Address: PO Box 1557, Rutherford, NJ 07070, USA
| RASIT is a 501(c)3 non-profit non-governmental organization associated with DPI - United Nations |