華藏衛星電視台海外服務中心

Hwazan Buddhist Foundation
P.O. Box 795819 Dallas, TX 75379-5819 U.S.A. 
  Tel: (972)579-7799  Fax: (972)579-7722

 http://www.hztv.org   Email: hwazantv.global@yahoo.com

信用卡捐款表/ Credit Card Donation Form
請印出此表，以較大的字體正楷填寫完畢後，傳真至(972) 579-7722
Please print out this page, fill it out clearly and fax to (972) 579-7722
 
 
  
Exact Name on the Card/卡上英文姓名：                                                                 
Billing Address of the Card/帳單住址：                                                     
 
 
 
 
 
 
Card Number/帳號：                                                                                     
Expiration Date(mm/yy) /有效期截止日(月月/年年)：                                        

       □ VISA   □ Master Card   □ American Express   □ Discover

Amount/款額：                                                             U.S. Dollar for
       □ One Time Donation/一次   □ Monthly Donation/每月  □ Others/其它
Chinese Name (if any)/中文名：                                                               
Contact Number (Phone)/電 話：                                                                              
 
E-mail Address/電子信箱：                                                                                        
 
 
Signature/簽名：                                                          Date /日期