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Donation Fax Form


Thank you for your generous gift. It enables us to fulfil the task and the vision the Lord has given to His church.

You can send your Donation to:

Chrisma Ministries to the Nations
Eikenlaan 86
3203 BL Spijkenisse
The Netherlands.

Instructions:
1) Fill out the required information.
2) Print out this page.
3) Fax this Form to: 31 (0)181 628365

First Name
Last Name
Address 1
Address 2
City
Postal Code
Country
Phone
Email
Donation Amount US$
Credit/ Debit Card Information: (Please select one) Visa   Master Card    Delta   Switch
Credit / Debit
Expiration Date    
Write your name as it appears on your credit card Signature:_____________________________________