Donations Form
Please fill in the form below
The LifeVision Foundation
ABC Newtownards
BT23 4YH

Tel: (44) 028 918 22122
Fax: (44) 028 918 22133
E-Mail: info@lifevision.org
First Name:
Surname:
E-mail:
Address:
Postcode:
Country:
If International:
Telephone:
Fax :

Donations

Single Donation £Once filled in proceed to Payments. eg £240, $410, €410.
Monthly Donation £Once filled in proceed to Monthly Direct Debit. eg £20, $35, €35.

 

Monthly Direct Debit

Bank  / Building Society Name
Bank Address
Account Holders Name
Branch Sort Code
Account Number

 

Payments:

Cheques

Please make the Cheque payable to The LifeVision Foundation and send to the address at  above
Credit card: Visa
Mastercard
Issue Number:
Card Number: ---
Expiry Date /
Card Holders name: