Section 1.

Your Full Name:
Street Address:
City:
State:
Zip:
Country:
Telephone Number:
E-Mail Address:

A. Please Enter your Donation amount

B. Please Check Payment Method: CheckCredit Card

C. Payments in any freely convertible Currency. Checks should be made payable to Shirdi Sai Baba Sanstha and mailed to address shown below.

For Credit Card Payments:
Check the Type of Credit Card : VisaMaster Card American ExpressDiscover

I hereby authorize Shirdi Sai Baba Sanstha , to bill my Credit Card as shown above for the donation amount listed above and I promise to pay such amount subject to and in accordance with the agreement governing the use of such card.

Authorizing Signature: Date: