PLEDGE FORM
I hereby authorise The Chaeli Campaign to draw against my account with the
bank indicated the sum of R………….. (…………………………………………..)
on the 3rd day of each and every month, commencing on ………………………
and continuing until cancelled by me in writing. This authority may be
cancelled by me by giving The Chaeli Campaign thirty (30) days notice in
writing.
NAME: …………………………………………………………………………………
COMPANY: ...…………………………………………………………………………
TEL: (landline) ……………………………………. (cell) …………………………
E-MAIL: …………..……………………………………………………………………
BANK: …….……………………………………………………………………………
ACCOUNT NAME: ………………………………………………………………...…
BRANCH NO: …….…………………………………………………………………
ACCOUNT NO: ………………….……………………………………………………
SIGNATURE : ………...………………………………………………………………
DATE: ……….…………………………………………………………………………
Please fill in this pledge form and fax it to 021-797 2926 and then approach your friends,
family, colleagues and business associates to support this initiative.
Each person WILL make a difference.