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Organisation Contact Details

Appeal Name:	Business to Community (B2C) Recyclers - "Sponsor A Computer" Appeal
Organisation Name:	WERX Foundation, The
Address:	Factory 19/391 Settlement Rd THOMASTOWN VIC 3074
Fax:	03 9465 6322
Phone:	03 9465 6300

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Donor Details — Please Print Clearly

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Address:
	Suburb	State	Postcode
Phone:	Home	Work
	Mobile	Fax
Email:

Payment Details — Please Print Clearly

I would like to donate		$	to WERX Foundation, The
	Enclosed is my cheque / money order
	Please charge my credit card

Credit Card Details

Card Type:	VISA   Mastercard
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Expiry Date:	/	CVV:
Cardholders Name:
Signature:
Date of Donation:

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