The Secretary Australian-German Welfare Society Inc. 4th Floor, 24 Albert Road South Melbourne VIC 3205 Donations for the Australian-German Welfare Society Inc. ABN 98 245 957 640 Please complete form: Mr./Mrs./Ms/Dr.…………………………………………………………………………...….. Address …………………………………………………………………………………. …………………………………………. Phone: …………………….…….. Donations: Administration Australian German Welfare Soc. Inc. Relief Fund* Tabulam and Templer Home for the Aged Inc. * * Donations of $ 2 and over are tax deductible $ …………………….. $ …………………….. $ …………………….. Total $ ============== If you wish to pay with your credit card please fill in the following: □ Visa □ Mastercard Creditcard Number: …………………………………………………………………………. Expiry Date ………………….. Print Name of the Cardholder ……………………………………………………………… Yes, I need a receipt. No, thanks, I don’t need a receipt. Signature …………………………………………………………………………………….