Application Fee - Printable Payment Form

Name:_____________________________________________________________

Mailing Address:___________________________________________________

__________________________________________________________________

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 Please find a check (cheque)/bank draft inclosed for US$250.00

I authorize the Global Volunteer Network to charge the (US$250.00) application fee to my credit card in the below currency:

 United States Dollars ($250.00)

Please select credit card type:

 Visa
 Mastercard
 American Express

Name (as it appears on the card):_________________________________

Card Number: _________________________________________________

Expiration Date: __________________

Is there any thing further you would like to know at this stage?

_____________________________________________________________

_____________________________________________________________

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Print this form and fax/post it to us at:

Global Volunteer Network Ltd,
P O Box 2231,
Wellington,
New Zealand.

Fax (within NZ) 08326 7788
Fax (from US) 01164 8326 7788
Fax (from CA) 01164 8326 7788
Fax (from UK) 0064 8326 7788
Fax (elsewhere) +++64 8326 7788

Please note: After you have posted or faxed the form. Can you please notify us at the following email address: payment@volunteer.org.nz - Thank you!

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