Happy Heart Foundation: Donation Form

Your Name :
*
Address :
Birthday :
     
Telephone :
Fax :
Mobile Phone :
E-mail :
*
I would like to make a single donation for,

The amount of    THB
I would like to donate for,(Indicate the amount of donation)  


(Please indicate)


  1 child


  2 children


  3 children

  or     children
  500 THB   Monthly

   1,500 THB		  
Every 3 months

  3,500 THB		  
Every 6 months

  6,500 THB		  
Yearly

Total THB
I would like to contribute towards education; (Indicate the amount of donation)  


(Please indicate)


  1 child


   2 children


  3 children

  or     children
  2,500 THB Yearly

  3,500 THB
Yearly

Total      THB
I would like to donate for "food expenses" (Indicate the amount of donation)  

   500 THB
Per month

   1,500 THB
Every 3 months

  3,500 THB
Every 6 months

   6,500 THB
Every year

Total     THB

TOTAL SUM:     THB  
***Monthly donation can be cancelled by request anytime.***



Donation Details

    Donation via bank or via ATM machines to "Happy Heart Foundation" account at your convenience.



TOTAL DONATION:  


    Cheque or cashier cheque should be crossed with A/C Payee Only and payable to "Happy Heart Foundation"

Bank      Cheque No.     Dated


TOTAL DONATION:



    Paypal




A receipt can be requested at 095-901-9555 .
Final