Waterfall Springs Donations Form

Donations over $2 are fully tax deductible.
If you require a receipt for tax purposes you must fill out all details.

Fill out and send to:

Waterfall Springs Wildlife Sanctuary
RMB 2394A, Kyola Road
KULNURA NSW 2250
Australia

Donor Details

Note: ** marks mandatory fields

Name:

Street Nº / Name:

Town/City:

State:                                                             Postcode/Zip:

Country:

Phone:                                                            Email:

Payment Details

**Payment Method, (please tick one): box Credit Card      box Cheque / Money Order

Credit card Details:
* *Card Type, (please tick one):  Master Card       Bank Card      Visa

**Card Name:

**Card Number: ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___

**Expiry Date:___ ___ / ___ ___

**Signature:

**Currency, (please tick one): Australian $ (preferred)     or      US$

**Donation Amount $ ______________________

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