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Donation form

Please fill out the form below.
* - required fields.
Name: *
Address: *
Phone: *
E-mail: *
www:

Donation:
*
Donation method: *
cheque (post to address below)
online banking (ref: "your name")
pledge the donation for a later date
pledge date

Comment:
We aim to list all donors publicly on a donors list. This helps motivate others to donate.
If you don't wish to be listed then untick the box below.
Please list me as a donor on this site on confirmation of my donation.


Bank details:ANZ
Account:010731 0141472 00
Account name:Kapiti Coast Rotary Pathways Trust
Postal address:Kapiti Coast Rotary Pathways Trust.
P O Box 248
Waikanae 5250

Please e-mail Treasurer(a)KCRPT.org.nz with any questions about donations.

Note: These details will only be used in direct relation to your donation.
Your details will not be recorded by this server except for your details required for our public donor list.
Your details will not be passed on to a third party.