CREDIT CARD AUTHORIZATION FORM

Name: ________________________________ Birthdate:__________________________

Home Address: _____________________________________________________________

Office Address: ____________________________________________________________

Home Tel. No. ____________________ Office Tel/Fax No.: ________________________

Cell No. ___________________________ E-mail Add: ____________________________

MODE OF GIVING

P 600 Monthly
P 3,600 Semi-annually

P 1,800 Quarterly
P 7,200 Annually

Master Card
RCBC-JCB

American Express
Visa

BPI Express Credit
BPI Master Card
Bank Name: __________________________________

Card Number:

ffff - ffff - ffff - ffff

Expiry Date: __________________________ Signature: ____________________

I authorize World Vision to deduct regular gifts/donations from my credit card

beginning the month of ______________ until further notice.

I authorize World Vision to deduct a one-time donation of P_________ from my
credit card.

Please FAX / EMAIL this form to: 374-7660 /wv_phil@wvi.org