WA Maccabi (Inc.)

Sporting Facilities Development
ASF Donation Form

ASF Project 206200

Please return this form to WA Maccabi (INC.)

The Centre, 61 Woodrow Avenue, Yokine 6059
Donor Details: (A Tax receipt will be issued in the following name. Please print clearly)
Title:    Mr.    Mrs.    Ms.    Miss    Dr    Other   
First Name:       
Last Name:   
Company Name (If required on receipt):       
Address:  
Town / Suburb:       
Phone (business hours):       
Email:   
Donation: Please find enclosed my donation of:
$100    $250    $500    $1000     $Other
I would like my gift to benefit the Western Australia Maccabi (Inc.) - Sporting Facilities Development Project. However, I
understand that my donation is made unconditionally to the Australian Sports Foundation.

Signature:        Date:   


Payment Details: (Please indicate your payment details by ticking the appropriate box)

Cheque*    Cash    Visa    Bankcard   

Amex**    Mastercard    Diners   
*Please make cheques payable to the Australia Sports Foundation Ltd.

Card Holder:       

Card Number:        Expiry:      

**Amex Code:   
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