Child Sponsorship Form

Child Information
Reference Number:*
Name of Child:*
Village/House*
Date of Birth:*
E-Mail
Important: Enter a valid e-mail address. Receipts will be sent to this address.
E-Mail:*
Billing Information
First Name:*		Same name as on your card
Middle Initial:
Last Name:*
Address Line 1:*		Where your statement is mailed
Address Line 2:		Apt. or Suite No.
City:*
State:*
Zip Code:*
Phone:*
Sponsorship Information
Sponsor a Child:	Monthly $25.00
Sponsor a Child:	Annually $300.00
Sub-Total:
Additional Donation:
Grand Total:
Credit/Debit Card Information
Card Number:*		No dashes or spaces please
Expiration Month:*		From your card
Expiration Year:*		From your card
Card Brand:*
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