Fernando Albano Partnership Mail Form

Please print out the following form, fill it out, and send it in to:

Fernando Albano,

Loving Christian Consultancy

P.O. Box 14124

Dar es Salaam, TANZANIA.

I. Personal Information

First Name: _____________________ Last Name: _______________________

Address Line 1: ________________________________________

Address Line 2: ________________________________________

City: ____________________ State: ______ Zip Code: ______________

Email address: _____________________________ Phone: ( ) _______ - __________

II. Credit Card Billing Address (if different from above)

First Name: _____________________ Last Name: _______________________

Address Line 1: ________________________________________

Address Line 2: ________________________________________

City: ____________________ State: ______ Zip Code: ______________

Email Address _______________________________

III. Donation Information

I would like to make a gift of USD ______________.

Or I would like to make a gift of TZS ______________.

This is a:	One time gift
	Monthly gift on the (14^th/_____) for: ________ months.

I prefer that my contribution be used for Fernando Albano Ministry with Loving Christian Consultancy :_____________.

Payment method:

MasterCard

Visa

American Express

Discover

Check

Other, please Contact me

Credit Card no. ________-________-________-________

Exp. Date (mm/yyyy): ____/______

I would like to give as:

Anonymous donation?	Yes	No
Please contact me	Yes	No

If you have any questions, please call + 255 - 784 - 77 79 79

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