Making a Donation - Kidney Support Network

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PO Box 16

THE GAP Q 4061

Phone: 07 3300 0906

Fax: 07 3300 0906

Making a Donation

A donation to the Kidney Support Network in memory of a loved one is a precious gift. It will help in the care and support of kidney patients and their families throughout Queensland.

When you wish to make your memorial gift, please fill in the information below. Your donation will be acknowledged with a receipt. Please note all donations over $2 are tax deductible.

We will inform the bereaved family of your memorial donation, keeping the amount confidential.

Name:

Address:

Phone:

Amount of Donation:

Please notify the bereaved family

Name:

Address:

Payment Options

□ Direct Deposit

□ Cheque

□ Credit Card

□ Send Invoice

Direct Deposit

Account Name: Kidney Support Network Inc. General Account

BSB: 064000

Account Number: 00051383

Please use ‘(last name) donation’ as reference

Credit Card Payment

Credit Card Number:

Name:

Expiry Date:

Please send to PO Box 16, The Gap QLD 4061.

Thank you again for your memorial gift, and for supporting Kidney Support Network.

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