Shirdi Sai Baba Sanstha - Donation Form

Shirdi Sai Baba Sanstha Donation Form
Contribute securely online or print form and contribute by mail or fax. See instructions below

*Section 1.* Your Details	Note:(*) indicates mandatory fields (+) indicates required fields when paying by credit card.
First Name:	*
Last Name:	*
Street Address One:	*
Street Address Two:
City:	*
State:	*
Zip:	*
Country:	*
Home or Cellphone Number:	*
Day or Workphone Number:
E-Mail Address:	*

Section 2. Payment Details

A. Enter your Donation amount in USD:	*
B. Please Check Payment Method:	CheckCredit Card *
C. For Credit Card Payments:
Check the Type of Credit Card :	VisaMaster Card American ExpressDiscover +
Enter your Credit Card Number:	+
Enter Credit Card Holder’s Name:	+
Enter Credit Card Expiration Date:(mm/dd/yy or mm/yy format)	+

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.

Write comments if any:

Signature:*	Date:(mm/dd/yy format) *

To donate by Credit Card, fill the form and hit the submit button. When you submit, your information will be securely transmitted over the internet using SSL encryption. Alternatively you can fax completed form to : (847) 931-4066.

To donate by Check make it payable to "Shirdi Sai Baba Sanstha", print and fill this form and please mail along with check to Shirdi Sai Baba Sanstha, 12N950 Route 47 Hampshire IL 60140, USA

Donations if made in USA are tax deductible under IRS section 501(c)(3). Tax ID 36-4400449. Please consult your tax advisor for details and eligibility

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