Shirdi Sai Temple Chicago Prasad Request Form
To recieve prasad and/or to make a love offering submit form securely online or print form and mail or fax.

Section 1. Your Details Note:(*) indicates required fields
         (+) indicates required fields if making a love offering online by credit card.
First Name:  *
Last Name:  *
Street Address One:  *
Street Address Two:
City: *
State: *
Zip: *
Country: *
Home or Cellphone Number: *
Day or Workphone Number:
E-Mail Address: *
Select Prasad Option: *

Section 2.  Love Offering Details
A. Enter your love offering amount in USD: +
B. Please Check Payment Method: CheckCredit Card     +
C. For Credit Card Payments:
Check the Type of Credit Card : VisaMaster Card
American ExpressDiscover +
Enter your Credit Card Number: +
Enter Credit Card Holder’s Name: +
Enter Credit Card Expiration Date:(mm/dd/yy or mm/yy format) +
I hereby authorize Shirdi Sai Baba Sanstha, to bill my Credit Card as shown above for the donation amount listed above and I promise to pay such amount subject to and in accordance with the agreement governing the use of such card.

Section 3.  Write comments if any, sign and date form.
Write comments if any:
Signature:* Date:(mm/dd/yyyy format) *

To donate by Credit Card, fill form and hit the submit button. When you submit, your information will be securely transmitted over the internet using SSL encryption. Alternatively you can fax completed form to : (847) 931-4066.

To donate by Check make check payable to "Shirdi Sai Baba Sanstha", print and fill this form and please mail along with check to Shirdi Sai Baba Sanstha, 12N950 IL Route 47, Hampshire, IL 60140, USA

Donations if made in USA are tax deductible under IRS section 501(c)(3). Tax ID 36-4400449. Please consult your tax advisor for details and eligibility



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