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Formulir Donasi

 

PERORANGAN

 

Nama lengkap             : …………………………………………………………………………………………………………………………….

Jenis kelamin              : …………………………………………………………………………………………………………………………….

Tempat / tgl. lahir         : ……………………………………………………………………………………………………………………………

Agama                        : ……………………………………………………………………………………………………………………………

Mobile                         : ……………………………………………………………………………………………………………………………

Email                          : ……………………………………………………………………………………………………………………………

Alamat lengkap            : ……………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………….

PERUSAHAAN

 

Nama lembaga         : ……………………………………………………………………………………………………………………………….

Jenis usaha              : ………………………………………………………………………………………………………………………………

Telp.                        : ………………………………….……………, Fax : ……………………………………………………………………..

Email                       : ………………………………………………………………………………………………………………………………

Website                   : ………………………………………………………………………………………………………………………………

Alamat lengkap         : ………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………….

 

BENTUK BANTUAN

 

Mendukung pelayanan Yayasan Mandiri Kreatif Indonesia dengan memberikan dukungan dana selama ………………. kali, sebesar  Rp.: ………………………………………………..…………….., mulai bulan …………………………………… tahun 20 ……..

Anda dapat mentransfer bantuan melalui:

-          Nama                             : YAYASAN MANDIRI KREATIF INDONESIA

-          Bank                              : DANAMON, Melawai, Jakarta Selatan

-          Nomor Rekening              : 3512284989

Correspondence Address:

Pasar Modern Mutiara Karawaci, Ruko Blok A23 Karawaci, (HARKIT), Tangerang 15810 – INDONESIA

Telp./Fax : (62-21) 5912189, Mobile : 0812 9886 6360, 0812 10181039, 0877 7852 4848

Email : yamakindo@yahoo.com

Website : www.yamakindo.org

 

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