Supporters > Contributions > Charity Voucher Order Form
Charity Voucher Order Form
Name:
*
Address:
Contact No:
*
(O)
(H)
(HP/Pager)
Email Address
*
I would like to place an order for
Ren Ci Hospital Charity Voucher for
an auspicious
an inauspicious occasion
for the amount of
S$50.00
S$250.00
S$100.00
S$500.00
Other amount (more than S$50.00)
EACH
Text to be inserted
Name of Recipient:
*
Message:
From:
*
Delivery Address:
*
Singapore
The total amount due S$:
S$
Preferred date of
*
delivery to recipient
(dd/mm/yyyy)
I wish to pay for the purchase(s) by:
Cheque
Bank
Chq No
For cheque payment:
- Please make cheque payable to Ren Ci Hospital & Medicare
Centre
- Mail it to 50 Jalan Tan Tock Seng, Singapore 308438
Credit Card
Copyright 2005 Ren Ci Hospital & Medicare Centre
