Commitment / Pledge Form

I pledge donation of (Description of Item):

Quantity:

Cost Pak Rs / US $ :

Name:

ADDRESS

Office:

Phone:

Fax:

Email:

Residence:

Phone:

Mode Of Payment:

Select an Option Option 1 Option 2 Option 3

Date by which payment shall be made:

The name you wish to be inscribed on the pledge:

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(You may like to get your own name inscribed on you may wish to choose the name of your dear one or company)