Last Name
Street Address
State
Zipcode
Mobile No
Address
City
Country
Phone No
Email
I wish to offer
 
 
Maha Daana (state the preferred facility or no. of units)
  INR USD
Bhu Daana (state the donation in square feet of land)
  INR USD
Total Offering INR USD

Payment Details
Draft/ Cheque No Drawn on Bank    Branch
Dated        
Postal Details  
Date Sent   Mode of Sending 
   
Wire Transfer  
Name of Bank
Account Name
Account Number
Wired on
Donor's Name in full
   
 
   
 
   
   
     
     
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