Donation Form

Donation Form

Enclosed is my donation/gift of amount: $______________

Name: _____________________________________________________

Address: ____________________________________________________

City/State/Zip: _______________________________________________

Telephone: __________________________________________________

Email: _____________________________________________________

The project I have choose to fund is #:_____________________

Project Name: ________________________________

We value your privacy as dearly as our own. We will not share any of your personal information with ANY third party. If you agree for The Phamile Foundation, to publish your name, picture and testimonial on our website, your other personal information will be kept completely private.

I agree for The Phamile Foundation, to publish on their website:
My name: ______YES _____NO
My motivation testimonial ______YES _____NO
To publish my picture (we will contact you by email): ______YES _____NO

Please write your motivation (testimonial) as why you made a donation/gift below:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Signature: ______________________________________ Date: ______________________

Your contribution is fully fax-deductible.
Thank you very much

The Phamile Foundation
13 Siri Lane Scotts Valley CA 95066 USA
Telephone: 415-812-5683 Website: www.Phamile.org E-mail: phamilefoundation@gmail.com