Financial Donation Form
Each Medical Wig costs atleast $350 USD, every cent that you donate is very much appreciated.

A donation of even $1.00 will help our non-profit ORG tremendously:
Name (First and Last Name) *
Your answer
Mobile Phone #: *
Your answer
E-mail Address: *
Your answer
How did you send your donation: *
Amount of Donation: *
Your answer
Date of donation: *
MM
/
DD
/
YYYY
Tracking No. (if by courier) / Transaction No. (if by paypal/bank) *
Your answer
The Country You Reside: *
Your answer
Your Facebook Page to Receive Certificate of Appreciation: *
Your answer
Once again, let us extend to you a warm and heartfelt ”Thank You" for your desire to help our women and children and for your sincere concern. We will wait for your kind reply.

GOD bless you for your support.

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