DONATE BY CHECK
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DONATE BY CHECK

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I would like to make a donation

 

If you would like to make a donation to support our efforts, please use the form below.
Donations can be made by check.

YES,I would like to make a donation:
to the association Heart and Coeur. :

25   35
45   60
Others :__________

  1. → Please print out a copy of our donation form and fill it in completely. If you are unable to print the donation form please supply us with the following information when you send your check.
    (First and last name - Address (street, city, state and zip/postal code) - Email address (if applicable) - Please indicate your donation)
  2. → Fill it in completely
  3. → Please make checks Payable to : heart and coeur
  4. → Send your check along with your completed donation form to :
    Association Heart and Coeur
    6, Avenue Leon Blum
    92 350 le Plessis Robinson
    France

    (we accept non Euros. currencies, but you can help us further by making your check payable in Euros, thereby saving us any foreign exchange fees – thank you).

Signature:



First Name:______________________________

Last Name :______________________________

Adress :_________________________________

_________________________________________

Zip :____________________________________

City:____________________________________

_ State:___________________________________

Country :________________________________

Phone (facultatif):_______________________

E-mail :_________________________________


Thank you for donating to Heart and Coeur

 


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