Healthy Skepticism Logo

Donation to Healthy Skepticism Inc

Please tick where appropriate and please print clearly.
We will contact you to thank you.

Please print this page, fill in and mail to:
Healthy Skepticism Inc
34 Methodist St
Willunga SA 5172
Australia

 

Your name:

 

Your email:

 

Your donation amount:

 

Your credit card:

[  ] Visa
[  ] MasterCard
[  ] Amex
(We are not able to accept other cards)

 

Card No:

 

Your card security code (CSC), sometimes called Card Verification Data (CVD), Card Verification Value (CVV or CVV2), Card Verification Value Code (CVVC), Card Verification Code (CVC or CVC2), Verification Code (V-Code or V Code), or Card Code Verification (CCV):

 

Expiry date:

 

Cardholder's name (if different from your name):

 

Your home address:

 

Your home phone number:

 

Cardholder's Signature: