Touch Africa - Pledge Form

Please fill out the form below and click 'send' to make your pledge.

Note: You can also download a PDF version of this form and fax it to us.
Click here to download the PDF.

Donor Information

Name

Billing Address

City

Province

Country

Telephone (home)

Telephone (business)

Fax

Pledge Information

I (we) pledge a total of R to be paid

I (we) plan to make this contribution in the form of

Credit Card Details

Credit Card Type

Credit Card Number

Expiration Date /

3 Digit Security Code

Donation Information

Gift will be matched by

Acknowledgement Information

Please use the following names in all acknowledgements:

Please make all checks, corporate matches or other gifts payable to:

Touch Africa