IWCT Philippine Dog Rescue

MONTHLY CREDIT CARD PAYMENTS

I authorise IWCT to debit once a month from my credit card account details as below:

Preferred date in month when payment to be deducted .......................................

Amount to be deducted £ ...................................................................... Thank You!

Name:

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Address:

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Post Code:

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Telephone:

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Fax:

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E-Mail:

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Visa / MasterCard Number

For security reasons, last 3 digits on back of credit card

Expiry date .................../..................

Today's date .................../...................

Signature ..........................................................................................................................

Please print name as it appears on your card ..................................................................

Please return this completed form to:

Charles Wartenberg
International Wildlife Coalition Trust
141A High Street
Edenbridge
Kent
TN8 5AX

Tel:
E-Mail:

(01732) 866955
iwcuk@iwcmail.demon.co.uk