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

You are visiting us from: Fairfield, CT, United States

Section 1. Your Details Note:(*) indicates required fields
         (+) indicates required fields if donating 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 (if any) details:
A. Enter your love offering amount in USD:: +
B. Select Donation Method: CheckCredit Card     +
C. For Credit Card Donations:
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) +
Enter CVV Code (3 or 4 digit code from back of Credit Card) +
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) *
Enter the six character code from the left column

To donate by Credit Card, fill the 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) 464-1567.

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 Temple, 12N950 IL Route 47, Hampshire, IL 60140, USA. Phone (847) 931 4058.

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
Shirdi Sai Baba Sanstha -

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