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DONOR FORM
Donor Information
Name
*
Title
First name
Last name
Business name
please include if making donations from your business only
Date of Birth
Gender
Male
Female
Address
Address line 1
Address line 2
City/Suburb
State/Territory
Postcode
Location
Australia
Canada
Egypt
New Zealand
South Africa
United Kingdom
USA
Home phone
Email address
*
Mobile phone
Amount
*
$100.00
$250.00
$500.00
Other amount
$
$100.00
$250.00
$500.00
Other
$
Pay processing fee
$
Total amount
$
Recurring period
*
Weekly
Every 2 weeks
Once per month
Pay/Donate method
*
Pay by Credit/Debit Card
Pay via Internet Banking
Make deposit to account
Please make an electronic bank transfer using the following details:
Pay to: Exodus
BSB 112 879
Account Number 465556041
Reference: Use your first and last name
Submit
Please check the highlighted fields
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