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Donation form in HTML

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freeGuppY

A non-profit-making association (1901 law)

 
                                                           
You have been wishing to make a donation to the freeGuppY association.
The procedures are quite simple :
  • à Carefully fill-in a printout of this donation form.
  • à Please make your cheque payable to the association freeGuppY.
  • à Then post it in a properly stamped envelope to the treasurer of the association :
Monsieur Yves LE BORGNE
Trésorier de l'association freeGuppY
22 rue du Trégor,
29490 Guipavas,
France


See you soon,
Associative greetings,

The president of freeGuppy

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logo.png
freeGupp Y
A non-profit-making association (1901 law)
 

DONATION FORM

[¯] I make a donation of :    ......................................€
Enclosed Cheque, payable to the association freeGuppY. Receipts are written with the name that shows in the identification box.

In agreement with the Internet Freedom and Information laws about data protection issues, the privacy of personal information and their exclusive use for the association purposes are guaranteed. You always retain control of your information with freeGuppY

     Title* : [¯] Mr,          [¯] Mrs,                 [¯] Ms,
                [¯] Firm,       [¯] Ldt Company,   [¯] Association, 
                [¯] other (specify)     ......................................

     Legal Form* :          [¯] Private             [¯] Company       [¯] Association
     Company name*     ......................................

     Surname*:     ......................................
     First name*:     ......................................
     Postal Address 1*:     ......................................
     Postal Address 2 :     ......................................
     Postal Code* :     ......................................
     Town * :     ......................................
     Country*:     ......................................
     E-mail*:     ......................................
     Username :     ......................................

     [¯] I give permission,
     [¯] I don't give permission
for my name or my image to be used for purposes of communication solely by freeGuppY.*
     You may enclose if you wish [¯] a passport photo, or [¯] a logo for legal entities.

     Made in     ...................................... on     ......................................
 
     Signature * (and stamp for moral entities) :  ......................................
 
  *=compulsory fields

Creation date : 12/06/2007 @ 04:13
Last update : 30/11/2013 @ 10:45
Category : Participation Promotion - Help freeGuppY
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