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Please enter your purchasing information below. Areas marked with a £££ are required fields.
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£££ Surname:__________________________________________________
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£££ First name:_________________________________________________
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| £££ Preferred Alias:_____________________________________________ |
| £££ Number of nearest phone box:________________________________ |
£££ Home address: _______________________________________________________________
_______________________________________________________________
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£££ Address of secluded car park where money can be exchanged: _______________________________________________________________
_______________________________________________________________
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£££ Next of kin:
_______________________________________________________________ _______________________________________________________________ |
£££ 'Would you like to keep using your credit card to keep donating for the next five years? (please tick)
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£££ How will we get our money?
American Express []
Donation Special Delivery Service (Wal-Mart Only) [] The Phone Booth In Kingston and 32nd [] |
Do you agree to be legally bound forevermore to our terms and conditions? []