DONATION FORM

Please print this form fill it and mail it to :
5661 Dykes Road
Davie, FL - 33331 USA
Phone - (954) 689-0471

Please make all checks payable to Shiva Vishnu Temple of South Florida.

I am enclosing $____________ as donation to the temple.

Last Name	___________________________________
First Name	___________________________________
Spouse	___________________________________

Address

Address 1	____________________________________
Address 2	____________________________________
Apt #	__________
	______________________________
State	______________________________
Country	______________________________
Zip	________-_______
Email Id	_______________________________________
Phone	______________________________
Comments	___________________________________________________ ___________________________________________________ ___________________________________________________

Your contribution is tax deductible. A receipt will be mailed to your address.

Thank You in advance for your patronage.