Queensland Blind Association Inc.

Donation Form

Name
Address
Phone
email
Company Name
Company Address
Please accept my donation of   $5
  $10
  $20
  $25
  $50
  $100
  Other
Other Amount
My cheque is enclosed   Yes
  No
or debit my
Card Holders Name
Account No.
Expiry Date
Signature








Please print this form and post to

Queensland Blind Association Inc.
PO Box 444
Annerley Qld 4103

Donations $2.00 and over are Tax Deductible. Every gift is appreciated. A receipt will be posted to you.

THANK YOU FOR YOUR SUPPORT.

IT IS MUCH APPRECIATED.









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