Amount

30 EUR50 EUR100 EUROther amount

Frequency:* onceonce every two monthsonce every quarteronce every six monthsannually

Personal details

private donationcompany donation

Title* MrMrsFamily

Company

First name*

Last name*

Street, No.*

Postal code/ City*

Email:

Account details

Account holder*

Account number*

Bank code*

Name of bank*

Intended purpose

I would like to give support wherever help is most needed.Other purpose (please note this under “Comments”)

Comments:

I/We hereby authorize AVC to debit the above amount from my/our account. This may be cancelled at any time.

Spam protection: Please enter the text in the image here: