DONATE VIA CREDIT CARD
(please print this page)
 

Send or fax your form to:

Master Choa Kok Sui Charitable Foundation Office

2210 Medical Plaza, San Miguel Avenue
Ortigas Center, Pasig City, Philppines 1805

Fax: +63 2 687-4726

For further information contact your Pranic Healing Center Representative or contact Master Daphne Bigcas at +632 635 9732 to 34 or e-mail wphf@iconn.com.ph

 

Please receive my gift of P_____________________

Name:___________________________Phone No( ____ ) _______________________

Fax No:__________________________E-mail:________________________________

Address:_______________________________________________________________

City:_____________________________Country:______________________________

Please charge my credit Card ( please check ) :

[   ]   VISA   [   ]   Mastercard   [   ]   Diners   [   ]   American Express   [   ]  BP

Card No:____________________________ Expiration date:____________________

Amount:___________________________



Signature:______________________________________________________________

Issuing Bank:___________________________________________________________

Card Billing Address