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| "UMA EDUCATION & TECHNICAL SOCIETY " Credit Card Payment Form |
| Credit
Card Payment Form for VISA and MASTER card |
Please
fill in the form and print it before mailing to the
given address
below |
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Name |
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Address |
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City |
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State |
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Zip/Pin
Code |
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Phone |
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E
mail |
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Yes!
I would like to donate towards"
UMA EDUCATION & TECHNICAL SOCIETY" an amount of |
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Rs |
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Credit
Card Type |
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Date
of Expiry |
DD
M
Y
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Credit
Card No |
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| Date of birth |
DD
M
Y
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Place |
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Date |
DD
M
Y
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Please
credit the said amount to
"UMA EDUCATION & TECHNICAL SOCIETY" |
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| Signature:
_____________________________ |
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Please
mail the form to the address below: |
…………………………Cut here to use below
text as address label………………………… |
"UMA EDUCATION & TECHNICAL SOCIETY"
Uma Manovikas Nagar
Behind Rayuduplaem
Vakalapudi Panchayat
Kakinada- 533 005
Andhra Pradesh, India
Telephone No: 0884- 2306039, 2307097,
Mobile : +91-98481 64779
Email : umamanovikas@yahoo.com
spreddy@umvk.org
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