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Church of Christ And Social Service Organisation Credit Card Payment Form

Credit Card Payment Form for VISA and MASTER card

Please fill in the form and print it before mailing to the
given address below

 
 

Name

 

Address

 
 

City

 

State

 
Zip/Pin Code
 
Phone
 
E mail
 
Yes! I would like to donate towards CHURCH OF CHRIST & SOCIAL SERVICE ORGANISATION an amount of
 
Rs
 
Credit Card Type
 
Date of Expiry

DD M Y

 
Credit Card No

Date of birth

DD M Y

 
Place
 
Date

DD M Y

Please credit the said amount to " CHURCH OF CHRIST & SOCIAL SERVICE ORGANISATION"
 
Signature: _____________________________
 
Please mail the form to the address below:
CHURCH OF CHRIST & SOCIAL SERVICE ORGANISATION
JANAKIPETA STREET, AMALAPURAM – 533201
Email: cocorg@rediffmail.com
Website: www.churchofchirst.com