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“serving society with love, care and compassion”

Donation
  1. Name of Individual/ Organisation(*)
    Please input full name
  2. IC No / Company. No(*)
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  3. Occupation (if applicable)
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  4. Address(*)
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  5. Email(*)
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  6. Home Phone
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  7. Office Phone
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  8. H/P
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  9. __________________________________________________________________________________________________________________________________________________

  10. PAYMENT DETAILS :
    Account Name : Persatuan Kebajikan Agape Melaka
    Account No : 039-201-200251-4
    Bank Name : AmBank Berhad
  11. __________________________________________________________________________________________________________________________________________________

  12. PAYMENT METHOD :
  13. Bank name
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  14. Cheque/transaction no
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  15. Amount
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    in MYR
  16. __________________________________________________________________________________________________________________________________________________
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  18. Please send completed form and bank-in slip via fax/email: +6063341121/agapecaremlk@gmail.com
  19. __________________________________________________________________________________________________________________________________________________
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  21. Please post complete form and cheque to
    AgapeCARE Society
    609, Taman Sri Indah, Kampong 8,
    75200 Melaka, Malaysia.

  22. __________________________________________________________________________________________________________________________________________________
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  24. *ALL DONATIONS TO AGAPECARE ARE TAX-EXEMPT
  25. __________________________________________________________________________________________________________________________________________________
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  27. Enter the numbers to eliminate spam:
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