Login to My Giving

Email:Password:

Join GiveNow to access My Giving

• view all your donations
• setup regular donations
• get donation summaries for your tax return

Print out the donation application below to:

• Send to your chosen organisation with your credit card details, cheque or money order
• Fax to your chosen organisation with your credit card details

---

Organisation Contact Details

Appeal Name:	Westside Circus Supporting Youth at Risk
Organisation Name:	Westside Circus Inc
Address:	Warehouse 3 433 Smith St FITZROY NORTH VIC 3065
Fax:	03 9489 9711
Phone:	03 9482 2088

---

Donor Details — Please Print Clearly

	Tick if you would like to remain anonymous (NB A tax invoice will not be sent)
Name:	Title	First Name	Last Name
Address:
	Suburb	State	Postcode
Phone:	Home	Work
	Mobile	Fax
Email:

Payment Details — Please Print Clearly

I would like to donate		$	to Westside Circus Inc
	Enclosed is my cheque / money order
	Please charge my credit card

Credit Card Details

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

---