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) *
Mobile Phone #: *
E-mail Address: *
How did you send your donation: *
Amount of Donation: *
Date of donation: *
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DD
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YYYY
Tracking No. (if by courier) / Transaction No. (if by paypal/bank) *
The Country You Reside: *
Your Facebook Page to Receive Certificate of Appreciation: *
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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