The Portsea Camp Giving Pledge Form
Your Details:
Full Name:
Email: ____________________________________________________________
Phone Number: ____________________________________________________________
Address: ____________________________________________________________
Suburb: _________________________ State: ____________ Postcode: ___________
Choose Your Level of Support:
Op>on 1: One-Off Dona>on
□ Yes, I would like to make a one-off donaAon of:
□ $25 □ $50 □ $100 □ $250 □ Other Amount: $_________
Direct Deposit donaAon to The Portsea Camp can be made to the following account:
Name: The Portsea Camp
BSB: 633 000
Account Number: 131 853 848
Op>on 2: Regular Giving Program
□ Yes, I would like to become a regular supporter of The Portsea Camp's "Making a Difference" programs for children:
□ Weekly : □ $10 □ $20 □ $30 □ Other Amount: $_________
□ Monthly: □ $50 □ $80 □ $120 □ Other Amount: $_________
Payment Method:
□ Credit Card: □ Visa □ Mastercard
Card Number: ____________________________________________________________
Expiry Date: ________ / ________ CVV: ________
Name on Card: ____________________________________________________________
□ Direct Debit (Please complete the bank details below):
Bank Name: ____________________________________________________________
Account Name: ____________________________________________________________
BSB Number: ________ - ________
Account Number: _________________________
Or at hFps://www.theportseacamp.com.au/cause/brighter-futures-for-every-child/#donate
Declara>on:
□ I understand that regular donaAons will be debited from my nominated account on the [e.g., 15th] of each [month/quarter] unAl I noAfy The Portsea Camp otherwise.
Signature: _________________________________________
Thank you for your generous support!
Date: _______________
Please return this form in the enclosed reply-paid envelope to:
The Portsea Camp 3704 Point Nepean Rd Portsea Vic 3944 or via email to: ceo@theportseacamp.com.au
All donaAons over $2 are tax-deducAble. A receipt will be issued for your contribuAon.
The Portsea Camp is an ACNC registered charity with both DGR and PBI charitable tax concession status.
ABN: 67 004 456 222
