長者安居服務協會

< 網上每月捐款 Online Monthly Donation>


本人願意以信用卡每月定期捐款予長者安居服務協會 I would like to donate to SCHSA by making a donation on a monthly basis by credit card

港幣 $： HK$	HK$100
	HK$500
	HK$1,000
	HK$2,500
	HK$5,000
	其他金額港幣 $
	Other amount will help HK$

直至另行通知為止 as agreed upon by me and Senior Citizen Home Safety Association until further notice.

( 網上捐款額由港幣 $50 至 $10,000) (Amount ranges from HK$50 to HK$10,000 for online donation) 只要每月捐款港幣100元或一次過捐款港幣2,500元，便可幫助一名長者或有需要人士終身免費享用「一線通平安鐘服務」。 Only a one-off donation of HK$2,500 or $100 per month can support an elder person or other person in need for life long usage of PE Link Service.

< 捐款者資料（*此欄必須填寫） Donor's Personal Information (*Required fields )>


中文姓名： Chinese Name:

英文姓名： * English Name: *

捐款者編號：(舊捐款者適用) Donor Ref. No. (if any)

聯絡電話： * Contact No.: *

傳真號碼： Fax No.:

電郵地址： Email Address:

地址： Postal Address:

	請寄回收據 Please send me receipt 若收據抬頭人並非捐款者，請填寫抬頭人之英文名稱: If the recipient’s name differs from the donor, please specify

	毋需發收據，以幫助節省行政開支。 To help save administration costs, please do not send me a receipt