Formulario para solicitar cobrador a domicilio.

<div style="text-align:right">BS'D</div>

<div style="text-align:justify">Si desea que un cobrador pase por su domicilio a retirar su donación o recibir un cupón para realizar la misma a través de Pago Fácil, por favor dejenos sus datos y a la brevedad nos estaremos contactando con usted. Muchas gracias.</div>

    Datos Personales:

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    Datos de la Donación:

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