I hereby declare,
| ________________________________ | |
| Name, firstname | |
| ________________________________ | |
| street | |
| ________________________________ | |
| zip code/city | |
| ________________________________ | |
| telephone | |
| that I accept a sponsorship for the support of a dog to the amount of monthly €_________ (Minimum € 12,00 per month). | |
| This amount will be paid quarterly and is without any obligation. For appreziation, I will receive a certificate of “my dog” after the payment is made. | |
| Mode of payment: | quarterly: |
| I would like a tax certificate: | yes / no (Please mark) |
| Mode of payment: | Banktransfer to the following account: |
| The sponsorship can volountarily be extended by the sponsor for three months until we found a home for the dog. Should we find a home before the three months, we can offer a refund. | |
| ________________________________ | |
| date/signature | |
| Christine Prochnow (1. Vorsitzende) Benzmannstr. 36 12167 Berlin Tel./FAX 030-796 13 07 Mobil 0171-687 34 68 |
Birgit Nispel (2. Vorsitzende) Am Wiesenrain 24 12587 Berlin Tel. : 030-641 97 182 Fax.: 030-644 88 092 |
Postanschrift: Christine Prochnow * Postfach 41 06 48 * 12116 Berlin