Donation Form

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Nepal Vision Inc.

USA

Donor’s Application Form

Date
Your Nameyour full name
Addressyour address
TelTel
Stateyour State
Received Amountyour amount
Type of Donationpick one!
Payment Type
Received Amountyour amount
Received amount in wordsyour amount
Amount Receipt No.Amount Receipt No.t
Contact NoContact No
Other Contact NoOther contact No
SignatureSignature
Date

Office Address: 72-15 41 Ave. Apt. B43, Woodside, NY 11377 

Cell: (347) 242-8594 

Mailing Address: P.O. Box 721050 Jackson Heights NY 11372 

Office: (315) 413-6612 

Email: nepalvisioninc@gmail.com

Web: www.nepalvision.org

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